Principles and practice to facilitate complete photodocumentation of the upper gastrointestinal tract: World Endoscopy Organization position statement

Abstract

Although esophagogastroduodenoscopy (EGD) is the most commonly used procedure in the gastrointestinal (GI) tract, the method of esophageal, gastric and duodenal mucosa photodocumentation varies considerably worldwide. One probable explanation is that for generations, EGD has primarily been taught by GI faculty and instructors based on their perceptions and experience, which has resulted in EGD being a nonstandardized procedure. Currently, the procedure is facing a challenging scenario as endoscopy societies are implementing procedure-associated quality indicators aiming for best practice among practitioners and evidence-based care for patients. Contrary to colonoscopy where cecum landmarks photodocumentation is considered proof of completeness, there are currently no reliable performance measures to gauge the completeness of an upper endoscopy nor guidance for complete photodocumentation. This World Endoscopy Organization (WEO) position statement aims to provide practical guidance to practitioners to carry out complete EGD photodocumentation. Hence, an international group of experts from the WEO Upper GI Cancer Committee formulated the following document using the body of evidence established through literature reviews, expert opinions, and other scientific sources. The group acknowledged that although the procedure should be feasible in any facility, what is needed to achieve a global shift on the concept of completeness is a common written statement of agreement on its potential impact and added value. This best practice statement offers endoscopists principles and practical guidance in order to carry out complete photodocumentation from the hypopharynx to the second duodenal portion.

History of conventional endoscopy for gastric evaluation in Japan

“…Anatomical landmarks, such as the incisura, cardiac orifice, and pyloric ring, should be recorded in a systematic and sequential manner for all cases. In 2020, a position statement by the World Endoscopy Organization recommended the Japanese photodocumentation process as the best practice for endoscopic screening of the upper GI tract 11 …”

“…In 2020, a position statement by the World Endoscopy Organization recommended the Japanese photodocumentation process as the best practice for endoscopic screening of the upper GI tract. 11 As more cancers are detected in their early stages, the need for endoscopic local resection techniques have also grown. A variety of endoscopic treatments for early gastric cancers, such as endoscopic mucosal resection and endoscopic submucosal dissection, have also been developed in Japan.…”

Circumferential endoscopic submucosal dissection for the treatment of ultra-short-segment Barrett’s adenocarcinoma with multifocal dysplasia

“…1 B). 4 Based on the contralateral location of these lesions and the likelihood of multifocal dysplasia, circumferential ESD aiming for en bloc R0 resection was scheduled.

Figure 1 Diagnosis of suspicious lesions and circumferential endoscopic submucosal dissection.

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¿Por qué es importante detectar la gastritis atrófica y la metaplasia intestinal gástrica? ¿Cuál es la forma adecuada de hacerlo?

“…Resulta importante aclarar que los estudios sobre la detección de CPCs y LPCs, fueron realizados por expertos, previa preparación de limpieza del estómago, y con un estudio meticuloso de la mucosa gástrica. En la práctica diaria, la mayoría de las EDAs se hacen sin una preparación previa, la cual demostró ser más eficaz (63,64) , sin eliminar adecuadamente todos los restos de la secreción mucosa pegada a la pared gástrica con el simple lavado y aspiración (65) , sin tomar el tiempo suficiente para evaluar de forma meticulosa y metodológica la mucosa gástrica, como la metodología de evaluación de la mucosa gástrica sugerida por Emura et al (endoscopia sistemática alfanumérica codificada) (66) y sin tomar siempre biopsias según el protocolo de Sydney en la primera EDA diagnóstica (67) . Estas limitaciones seguramente impactan negativamente en nuestra capacidad de reconocimiento de las CPCs y LPCs (cuya detección permite un seguimiento y manejo apropiado) y del CGT (cuyo tratamiento tiene un excelente pronóstico).…”