Canadian credentialing guidelines for esophagogastroduodenoscopy.

1Division of Gastroenterology, University of Western Ontario, London, Ontario; 2Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia; 3Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA; 4St Joseph’s Health Centre, Toronto, Ontario; 5Division of Gastroenterology, McMaster University, Hamilton, Ontario; 6Division of Gastroenterology, McGill University, Montreal, Quebec Correspondence: Dr David Armstrong, Division of Gastroenterology, HSC-2F55, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5. Telephone 905-521-2100 ext 76404, fax 905-523-6048, e-mail [email protected] Received and accepted for publication March 16, 2008 Aseries of credentialing guidelines for gastrointestinal endoscopic procedures performed in the management of adult patients has been developed by the Canadian Association of Gastroenterology (CAG) Endoscopy Committee. The guidelines were approved by the Clinical Affairs Committee, and reviewed and endorsed by the Executive Board. In the present article, the CAG suggests specific guidelines for credentialing esophagogastroduodenoscopy (EGD), also known as gastroscopy or upper gastrointestinal endoscopy. It is intended to be read in conjunction with the introductory article that outlines the principles of credentialing (1). The CAG does not credential individuals for EGD; that is the responsibility of the endoscopist’s local institution or facility. The purpose of these guidelines is to provide a framework that will allow organizations to assess the training and competence of applicants to perform EGD, as part of the credentialing process for the granting of privileges. Credentialing for EGD, addressed in previous guidelines from the CAG (2), the American Society for Gastrointestinal Endoscopy (3) and others (1,4) will be reviewed with respect to issues relevant to Canadian practice. The CAG credentialing criteria for EGD apply to the investigation of adult patients, aged 18 years or older. The basic principles also apply to EGD in pediatric patients but, because the number of procedures required to achieve and maintain competence may differ, guidance on credentialing for pediatric endoscopy is considered to be the responsibility of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. EGD is performed with a specialized flexible endoscope that is passed via the mouth and advanced, generally, to the second or third part of the duodenum to visualize the upper gastrointestinal tract. EGD may be undertaken for diagnosis (encompassing written documentation, photodocumentation and, when appropriate, mucosal biopsy) or for therapy (including polyp removal, percutaneous endoscopic gastrostomy [PEG] tube insertion, stricture dilation, variceal ablation, endoscopic mucosal resection, photodynamic therapy and hemostasis), while minimizing procedure-related risks such as excessive sedation, cardiorespiratory compromise, bleeding and perforation.