ASGE Guidelines

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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. For more information, see the American Society for Gastrointestinal Endoscopy clinical practice guideline development policy and checklist.

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

Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer

Mar 13, 2020, 14:03 PM
Colonoscopy with polypectomy reduces the incidence of and mortality from colorectal cancer (CRC). It is the cornerstone of effective prevention. The National Polyp Study showed that removal of adenomas during colonoscopy is associated with a reduction in CRC mortality by up to 50% relative to population controls.1,2 The lifetime risk to develop CRC in the United States is approximately 4.3%, with 90% of cases occurring after the age of 50 years. The recent reductions in CRC incidence and mortality have been largely attributed to the widespread uptake of CRC screening with polypectomy. The techniques and outcomes of polyp removal using colonoscopy, however, had historically remained understudied and thus, practice widely varied. Reports have shown that residual tissue after polypectomy that is judged to be “complete” by the endoscopist is common, ranging from 6.5% to 22.7%. The significant variation in incomplete resection rates among endoscopists has highlighted the dependence of polypectomy effectiveness on operator technique. A pooled analysis from 8 surveillance studies that followed participants with adenomas after a baseline colonoscopy suggested that although the majority (50%) of post-colonoscopy colon cancers were likely due to missed lesions, close to one-fifth of incident cancers were related to incomplete resection. Polypectomy techniques have expanded in parallel with advances in endoscopic imaging, technology, and tools. Optimal techniques encompass effectiveness, safety, and efficiency. Colorectal lesion characteristics, including location, size, morphology, and histology, influence the optimal removal method. For example, the applications of cold snare polypectomy for small lesions, which can remove adenomatous tissue en bloc with surrounding normal mucosa, and endoscopic mucosal resection (EMR) for large and flat lesions, which utilizes submucosal injection to lift the lesion before snare resection, have evolved to improve complete and safer resection. The primary aim of polypectomy is the complete and safe removal of the colorectal lesion and the ultimate prevention of CRC. This consensus statement provides recommendations to optimize complete and safe endoscopic removal techniques for colorectal lesions (Table 1), based on available literature and experience. The recommendations from the US Multi-Society Task force (USMSTF) on the management of malignant polyps, polyposis syndromes, and surveillance after colonoscopy and polypectomy are available in other documents. Table 2 summarizes abbreviations and definitions of terms utilized in these recommendations.
Tonya Kaltenbach, Joseph C. Anderson, Carol A. Burke, Jason A. Dominitz, Samir Gupta, David Lieberman, Douglas J. Robertson, Aasma Shaukat, Sapna Syngal, Douglas K. Rex
Title : Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer
Doi org link : https://doi.org/10.1016/j.gie.2020.01.029
Volume : Gastrointest Endosc 2020; Volume 91, Issue 3; P486-519
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GRADE Guidelines
Upper GI
Lower GI

Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer

Mar 13, 2020, 14:03 PM
Colonoscopy with polypectomy reduces the incidence of and mortality from colorectal cancer (CRC). It is the cornerstone of effective prevention. The National Polyp Study showed that removal of adenomas during colonoscopy is associated with a reduction in CRC mortality by up to 50% relative to population controls.1,2 The lifetime risk to develop CRC in the United States is approximately 4.3%, with 90% of cases occurring after the age of 50 years. The recent reductions in CRC incidence and mortality have been largely attributed to the widespread uptake of CRC screening with polypectomy. The techniques and outcomes of polyp removal using colonoscopy, however, had historically remained understudied and thus, practice widely varied. Reports have shown that residual tissue after polypectomy that is judged to be “complete” by the endoscopist is common, ranging from 6.5% to 22.7%. The significant variation in incomplete resection rates among endoscopists has highlighted the dependence of polypectomy effectiveness on operator technique. A pooled analysis from 8 surveillance studies that followed participants with adenomas after a baseline colonoscopy suggested that although the majority (50%) of post-colonoscopy colon cancers were likely due to missed lesions, close to one-fifth of incident cancers were related to incomplete resection. Polypectomy techniques have expanded in parallel with advances in endoscopic imaging, technology, and tools. Optimal techniques encompass effectiveness, safety, and efficiency. Colorectal lesion characteristics, including location, size, morphology, and histology, influence the optimal removal method. For example, the applications of cold snare polypectomy for small lesions, which can remove adenomatous tissue en bloc with surrounding normal mucosa, and endoscopic mucosal resection (EMR) for large and flat lesions, which utilizes submucosal injection to lift the lesion before snare resection, have evolved to improve complete and safer resection. The primary aim of polypectomy is the complete and safe removal of the colorectal lesion and the ultimate prevention of CRC. This consensus statement provides recommendations to optimize complete and safe endoscopic removal techniques for colorectal lesions (Table 1), based on available literature and experience. The recommendations from the US Multi-Society Task force (USMSTF) on the management of malignant polyps, polyposis syndromes, and surveillance after colonoscopy and polypectomy are available in other documents. Table 2 summarizes abbreviations and definitions of terms utilized in these recommendations.
Tonya Kaltenbach, Joseph C. Anderson, Carol A. Burke, Jason A. Dominitz, Samir Gupta, David Lieberman, Douglas J. Robertson, Aasma Shaukat, Sapna Syngal, Douglas K. Rex
Title : Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer
Doi org link : https://doi.org/10.1016/j.gie.2020.01.029
Volume : Gastrointest Endosc 2020; Volume 91, Issue 3; P486-519
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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 management of esophageal and gastric varices in patients with cirrhosis

Comment