ASGE Guidelines

ASGE evidence-based guidelines provide clinicians with recommendations for the evaluation, diagnosis, and management of patients undergoing endoscopic procedures of the digestive tract. Guidelines are not a substitute for physicians’ opinion on individual patients. Final decision on an intervention should always be based on local expertise and patient preferences.

All recommendations follow a rigorous process based on a systematic review of medical literature as outlined by the National Academy of Medicine (formerly Institute of Medicine) standards for guideline development.

Whenever possible, guidelines are based on the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology.

Panels consist of content experts, stakeholders from other specialties, patient representatives, and members of the ASGE Standards of Practice (SOP) Committee.

Each recommendation is based on consideration of the best medical literature, the balance between risks and benefits, cost-effectiveness, patients’ values, and equity.

Panel members provide ongoing conflict of interest (COI) disclosures, including intellectual conflicts of interest, throughout the development and publication of all guidelines in accordance with the ASGE Policy for Managing Declared Conflicts of Interests.

ASGE strives to provide clinically relevant and practical recommendations, which can help standardize patient care and improve outcomes.

If you have any questions or suggestions, please contact Customer Support at Info@asge.org.

The following information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.

Newly Published
GRADE Guidelines

Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer

Apr 2, 2018, 09:59 AM
Barrett’s esophagus (BE) is defined by the replacement of the normal squamous epithelium of the distal esophagus with metaplastic intestinal-type columnar epithelium.1, 2, 3 BE is an adverse event of chronic GERD and the only identifiable premalignant condition for esophageal adenocarcinoma (EAC), a cancer that continues to increase in incidence. In 2014 there were approximately 18,170 incident cases of esophageal cancer in the United States, nearly 60% of which were EAC.4, 5, 6 Although uncommon, EAC is a highly lethal cancer associated with a poor 5-year survival rate of 15% to 20% and an overall median survival of <1 year in cases with advanced disease.5, 6, 7 It is estimated that BE is present in 1% to 2% of the general adult population.8, 9 The stepwise and hypothesized progression of BE to invasive EAC is believed to occur through the histopathologic stages of intestinal metaplasia to low-grade dysplasia (LGD) to high-grade dysplasia (HGD) to intramucosal EAC and finally to invasive EAC.3, 10, 11, 12, 13 Endoscopic eradication therapy (EET) has significantly changed the management of patients with BE-related neoplasia and allows a minimally invasive treatment approach that avoids the morbidity and mortality associated with esophagectomy. Contemporary EET, supported by published literature, entails endoscopic mucosal resection (EMR) of visible lesions within the Barrett’s segment and ablative techniques that include radiofrequency ablation (RFA) and cryotherapy. Several studies, including randomized controlled trials (RCTs), large observational studies, and population-based studies, have demonstrated the efficacy, effectiveness, and safety of EET to achieve complete eradication of intestinal metaplasia (CE-IM) and neoplasia while maintaining disease remission.14, 15, 16, 17, 18, 19, 20, 21, 22 In addition, population-based studies report comparable outcomes between esophagectomy and EET in the management of BE-related HGD and mucosal EAC.23 Available data suggest that EET is being performed not only at academic and tertiary care centers but also among community practices.14, 18
Standards of Practice Committee, Sachin Wani, MD∗ , Bashar Qumseya, MD, MPH∗ , Shahnaz Sultan, MD , Deepak Agrawal, MD , Vinay Chandrasekhara, MD , Ben Harnke, PhD , Shivangi Kothari, MD , Martin McCarter, MD , Aasma Shaukat, MD, MPH , Amy Wang, MD , Julie Yang, MD , John Dewitt, MD
Title : Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer
Doi org link : https://doi.org/10.1016/j.gie.2017.10.011
Volume : Gastrointest Endosc 2018; Volume 87, Issue 4; P907-931.E9
URL : http://www.giejournal.org/article/S0016-5107(17)32408-2/fulltext
Select a choice : Keep
Content created : Feb 3, 2018, 00:00 AM
File size :
Number :
ExternalPK :

Categories :
  • Egd With Biopsy
  • Esophagus
  • Procedures
  • Upper GI
Tags :
  • EGD
  • esophagus
  • Upper GI
Upper GI

Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer

Apr 2, 2018, 09:59 AM
Barrett’s esophagus (BE) is defined by the replacement of the normal squamous epithelium of the distal esophagus with metaplastic intestinal-type columnar epithelium.1, 2, 3 BE is an adverse event of chronic GERD and the only identifiable premalignant condition for esophageal adenocarcinoma (EAC), a cancer that continues to increase in incidence. In 2014 there were approximately 18,170 incident cases of esophageal cancer in the United States, nearly 60% of which were EAC.4, 5, 6 Although uncommon, EAC is a highly lethal cancer associated with a poor 5-year survival rate of 15% to 20% and an overall median survival of <1 year in cases with advanced disease.5, 6, 7 It is estimated that BE is present in 1% to 2% of the general adult population.8, 9 The stepwise and hypothesized progression of BE to invasive EAC is believed to occur through the histopathologic stages of intestinal metaplasia to low-grade dysplasia (LGD) to high-grade dysplasia (HGD) to intramucosal EAC and finally to invasive EAC.3, 10, 11, 12, 13 Endoscopic eradication therapy (EET) has significantly changed the management of patients with BE-related neoplasia and allows a minimally invasive treatment approach that avoids the morbidity and mortality associated with esophagectomy. Contemporary EET, supported by published literature, entails endoscopic mucosal resection (EMR) of visible lesions within the Barrett’s segment and ablative techniques that include radiofrequency ablation (RFA) and cryotherapy. Several studies, including randomized controlled trials (RCTs), large observational studies, and population-based studies, have demonstrated the efficacy, effectiveness, and safety of EET to achieve complete eradication of intestinal metaplasia (CE-IM) and neoplasia while maintaining disease remission.14, 15, 16, 17, 18, 19, 20, 21, 22 In addition, population-based studies report comparable outcomes between esophagectomy and EET in the management of BE-related HGD and mucosal EAC.23 Available data suggest that EET is being performed not only at academic and tertiary care centers but also among community practices.14, 18
Standards of Practice Committee, Sachin Wani, MD∗ , Bashar Qumseya, MD, MPH∗ , Shahnaz Sultan, MD , Deepak Agrawal, MD , Vinay Chandrasekhara, MD , Ben Harnke, PhD , Shivangi Kothari, MD , Martin McCarter, MD , Aasma Shaukat, MD, MPH , Amy Wang, MD , Julie Yang, MD , John Dewitt, MD
Title : Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer
Doi org link : https://doi.org/10.1016/j.gie.2017.10.011
Volume : Gastrointest Endosc 2018; Volume 87, Issue 4; P907-931.E9
URL : http://www.giejournal.org/article/S0016-5107(17)32408-2/fulltext
Select a choice : Keep
Content created : Feb 3, 2018, 00:00 AM
File size :
Number :
ExternalPK :

Categories :
  • Egd With Biopsy
  • Esophagus
  • Procedures
  • Upper GI
Tags :
  • EGD
  • esophagus
  • Upper GI
Lower GI
Biliary and Pancreatic Endoscopy
Adverse Events
Privileging and Credentialing
GI Endoscopy Unit Operations
Screening and Surveillance in Premalignant Conditions
Procedural Management in Endoscopy
Miscellaneous
Guidelines in Spanish

In Progress Guidelines

ASGE Guideline on management of code status in the periendoscopic period

Estimated 2025

Quality in Endoscopy

Quality documents define the indicators of high-quality endoscopy and how to measure it. ASGE quality indicators are based on a rigorous review process which results in valid metrics for evaluating GI endoscopic procedures.

Quality in Endoscopy

Public Comment

ASGE guidelines approaching publication are available on the website for 30 days for public comment. All reviewers are required to submit a conflict-of-interest disclosure and acknowledge a non-disclosure agreement for the guideline draft. All comments will be reviewed by the SOP Committee. Revisions to the draft are at the discretion of the lead authors and the SOP Committee.

ASGE Guideline on endoscopic management of benign and malignant colonic strictures

Comment

Endoscopic treatment for the management of complications post bariatric surgery: European Society of Gastrointestinal Endoscopy and American Society of Gastrointestinal Endoscopy position statement

Comment