Preservation and Incorporation of Valuable endoscopic Innovations (PIVI)

The PIVI initiative is an ASGE program whose objectives are to identify important clinical questions related to endoscopy and to establish a priori diagnostic and/or therapeutic thresholds for endoscopic technologies designed to resolve these clinical questions. Additionally, PIVIs may also outline the data and or the research study design required for proving an established threshold is met. Once endoscopic technologies meet an established PIVI threshold, those technologies are appropriate to incorporate into clinical practice, presuming the appropriate training in that endoscopic technology has been achieved. ASGE encourages and supports the appropriate use of technologies that meet its established PIVI thresholds.

The PIVI initiative was developed primarily to direct endoscopic technology development toward resolving important clinical issues in endoscopy. The PIVI initiative is also designed to minimize the possibility that potentially valuable innovations are prematurely abandoned due to lack of utilization and to avoid widespread use of an endoscopic technology before clinical studies documenting their effectiveness have been performed. The PIVI document, defines the diagnostic or therapeutic threshold that must be met for a technique or device to become considered appropriate for incorporation into clinical practice. It is also meant to serve as a guide for researchers or those seeking to develop technologies that are designed to improve digestive health outcomes.

An ad hoc committee, under the auspices of the existing ASGE Technology and Standards of Practice Committees Chairs, develops PIVIs. An expert in the subject area chairs the PIVI, with additional committee members chosen for their individual expertise. In preparing the document, evidence-based methodology is employed, using a MEDLINE and PubMed literature search to identify pertinent clinical studies on the topic. PIVIs are ultimately submitted to the ASGE Governing Board for approval, as is done for all Technology and Standards of Practice documents. This document is provided solely for educational and informational purposes and to support incorporating these endoscopic technologies into clinical practice. It should not be construed as establishing a legal standard of care.


Peroral endoscopic myotomy
Paper as published in GIE [.pdf] 

Real-Time Endoscopic Assessment of the Histology of Diminutive Colorectal Polyps
Summary as published in GIE [.pdf] 
Long Version PIVI [.pdf]

Endoscopic Bariatric Procedures
White paper: “A Pathway to Endoscopic Bariatric Therapies” by the ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy, as published in GIE [.pdf].
Summary PIVI [.pdf]

Imaging in Barrett's Esophagus
Long Version [.pdf]
Summary PIVI [.pdf]

Use of Endoscopy Simulators for Training and Assessing Skill
Summary Version as published in GIE [.pdf]
Simulator PIVI Long Version