ASGE Guidelines

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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.

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. 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

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Adverse Events

Adverse events associated with EGD and EGD-related techniques

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Adverse events associated with EUS and EUS-guided procedures

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Adverse events associated with ERCP

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Screening and Surveillance in Premalignant Conditions

Procedural Management in Endoscopy

Guidelines for sedation and anesthesia in GI endoscopy

Jan 30, 2018, 15:03 PM

This document is an update of guidelines for sedation and anesthesia in endoscopy prepared by the Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE). In preparing this guideline, a search of the medical literature was performed by using PubMed from January 1980 through August 2017 that related to the topic of “sedation and anesthesia for gastrointestinal endoscopy” by using the keyword(s) “sedation,” “anesthesia,” “gastrointestinal endoscopy,” “endoscopy,” “endoscopic procedures,” and “procedures.” The search was supplemented by accessing the “related articles” feature of PubMed, with articles identified on PubMed as the references. Pertinent studies published in English were reviewed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data existed from well-designed prospective trials, emphasis was given to results from large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines were drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations were based on reviewed studies and were graded on the strength of the supporting evidence by using the GRADE criteria (Table 1).1

ASGE Standards of Practice Committee, Dayna S. Early, MD, FASGE , Jenifer R. Lightdale, MD, MPH, FASGE , John J. Vargo II, MD, MPH, FASGE (invited content expert, ad hoc member) , Ruben D. Acosta, MD , Vinay Chandrasekhara, MD , Krishnavel V. Chathadi, MD , John A. Evans, MD , Deborah A. Fisher, MD, MHS, FASGE , Lisa Fonkalsrud, BSN, RN, CGRN , Joo Ha Hwang, MD, PhD, FASGE , Mouen A. Khashab, MD , V. Raman Muthusamy, MD, FASGE , Shabana F. Pasha, MD, FASGE , John R. Saltzman, MD, FASGE , Amandeep K. Shergill, MD , Brooks D. Cash, MD, FASGE (Previous Committee Chair) , John M. DeWitt, MD, FASGE (Committee Chair)

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Title : Guidelines for sedation and anesthesia in GI endoscopy

Doi org link : http://dx.doi.org/10.1016/j.gie.2017.07.018

Volume : Gastrointest Endosc 2018; Volume 87, Issue 2; P327-337

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Abbreviations

Guyatt, G.H. ∙ Oxman, A.D. ∙ Vist, G.E. ...

GRADE: an emerging consensus on rating quality of evidence and strength of recommendations

BMJ. 2008; 336:924-926

Quality of evidence	Definition	Symbol
High quality	Further research is very unlikely to change our confidence in the estimate of effect.	⊕⊕⊕⊕
Moderate quality	Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.	⊕⊕⊕○
Low quality	Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.	⊕⊕○○
Very-low quality	Any estimate of effect is very uncertain.	⊕○○○

	Minimal sedation (anxiolysis)	Moderate sedation (conscious sedation)	Deep sedation	General anesthesia
Responsiveness	Normal response to verbal stimulation	Purposeful response to verbal or tactile stimulation	Purposeful response after repeated or painful stimulation	Unarousable even with painful stimulus
Airway	Unaffected	No intervention required	Intervention may be required	Intervention often required
Spontaneous ventilation	Unaffected	Adequate	May be inadequate	Frequently inadequate
Cardiovascular function	Unaffected	Usually maintained	Usually maintained	May be impaired

Class	Description
I	The patient is normal and healthy.
II	The patient has mild systemic disease that does not limit activities (eg, controlled hypertension or controlled diabetes without systemic sequelae).
III	The patient has moderate or severe systemic disease that does not limit activities (eg, stable angina or diabetes with systemic sequelae).
IV	The patient has severe systemic disease that is a constant threat to life (eg, severe congestive heart failure, end stage renal failure).
V	The patient is morbid and is at a substantial risk of death within 24 hours (with or without a procedure).
E	Emergency status: in addition to indicating the underlying ASA status (I-V), any patient undergoing an emergency procedure is indicated by suffix “E.”