{
  "abstract": "Background National root cause analysis of post-endoscopy upper gastrointestinal (UGI) cancer in England has found wide variations in UGI endoscopy quality. This guidance aims to provide a practical UGI endoscopy guide to improve procedural quality, optimise early malignant and pre-malignant lesion detection and common pathology managment.Methods An initial consensus document was drafted in 2023 by the Scottish National Endoscopy Training Programme. A Guidance Development Group including endoscopy academy and regional endoscopy leads, devolved nation, JAG, AUGIS and BSG representatives was subsequently convened to adapt the document for UK-wide use. Targeted literature reviews were undertaken to provide evidence where available and recommendations were refined through expert consensus.Results High quality UGI examination is facilitated by closed mouth local anaesthetic spray application and combined sedation with opioids and benzodiazepines when sedation is needed. Mucosal cleansing with Simethicone and N-Acetyl Cysteine is recommended. Systematic inspection is recommended during diagnostic UGI endoscopy: first full oesophageal assessment using both white light and digital chromoendoscopy (facilitates squamous neoplasia detection); then complete gastric examination with white light in retroflexion and antegrade, with virtual chromendoscopy for any focal abnormality; and finally duodenal examination.In Barrett’s oesophagus, following mucosal cleansing and white light examination, virtual chromoendoscopy and acetic acid enhance dysplasia detection. When gastric atrophy or intestinal metaplasia are suspected, virtual chromoendoscopy with targeted biopsies, if a focal lesion is present, and Sydney protocol biopsies to establish the extent of atrophy/metaplasia are recommended.Conclusions Optimising mucosal visualisation through sedation when appropriate, mucosal cleansing and chromoendoscopy enhances recognition of pre-malignant and early maligant lesions in the oesophagus and stomach and is recommended.",
  "authors": [
    {
      "affiliations": [
        "Gastroenterology, Sandwell West Birmingham Hospitals NHS Trust, Birmingham, UK"
      ],
      "name": "Shahd A Mohamed"
    },
    {
      "affiliations": [
        "Department of General Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK"
      ],
      "name": "Jeyakumar Apollos"
    },
    {
      "affiliations": [
        "Gastroenterology, Cheltenham General Hospital, Cheltenham, Gloucestershire, UK"
      ],
      "name": "John Anderson"
    },
    {
      "affiliations": [
        "GI Services, University College London Hospitals NHS Foundation Trust, London, UK"
      ],
      "name": "Matthew Banks"
    },
    {
      "affiliations": [
        "Gastroenterology, NHS Greater Glasgow and Clyde, Glasgow, UK",
        "National Endoscopy Training Programme, Clydebank, UK"
      ],
      "name": "Aidan Cahill"
    },
    {
      "affiliations": [
        "Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "James Catton"
    },
    {
      "affiliations": [
        "Gastroenterology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK",
        "South East Endoscopy Training Academy, Redhill, UK"
      ],
      "name": "Matthew Cowan"
    },
    {
      "affiliations": [
        "Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"
      ],
      "name": "Benjamin R Disney"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK",
        "Joint Advisory Group on Gastrointestinal Endoscopy, London, UK"
      ],
      "name": "Paul Dunckley"
    },
    {
      "affiliations": [
        "National Endoscopy Training Programme, Clydebank, UK",
        "Gastroenterology, NHS Borders, Melrose, UK"
      ],
      "name": "Jonathan Fletcher"
    },
    {
      "affiliations": [
        "Gastroenterology, NHS Greater Glasgow and Clyde, Glasgow, UK",
        "National Endoscopy Training Programme, Clydebank, UK"
      ],
      "name": "Andrew Fraser"
    },
    {
      "affiliations": [
        "General Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK"
      ],
      "name": "Joanna Gray"
    },
    {
      "affiliations": [
        "Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UK"
      ],
      "name": "John T Green"
    },
    {
      "affiliations": [
        "Joint Advisory Group on Gastrointestinal Endoscopy, London, UK",
        "Gastroenterology, Wye Valley NHS Trust, Hereford, UK"
      ],
      "name": "Helen Griffiths"
    },
    {
      "affiliations": [
        "Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK"
      ],
      "name": "Hasan Haboubi"
    },
    {
      "affiliations": [
        "Gastroenterology, Bolton NHS Foundation Trust, Bolton, UK",
        "North West Endoscopy Training Academy, Bolton, UK"
      ],
      "name": "Neil Haslam"
    },
    {
      "affiliations": [
        "National Endoscopy Training Programme, Clydebank, UK",
        "Gastroenterology, NHS Dumfries and Galloway, Dumfries, UK"
      ],
      "name": "Tammy Kingstree"
    },
    {
      "affiliations": [
        "National Endoscopy Training Programme, Clydebank, UK",
        "General Surgery, NHS Lanarkshire, Bothwell, UK"
      ],
      "name": "Audrey Mccallum"
    },
    {
      "affiliations": [
        "National Endoscopy Training Programme, Clydebank, UK",
        "Gastroenterology, NHS Lothian, Edinburgh, UK"
      ],
      "name": "Aaron P McGowan"
    },
    {
      "affiliations": [
        "National Endoscopy Training Programme, Clydebank, UK",
        "General Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK"
      ],
      "name": "Douglas Morran"
    },
    {
      "affiliations": [
        "NHS Greater Glasgow and Clyde, Glasgow, UK"
      ],
      "name": "Allan John Morris"
    },
    {
      "affiliations": [
        "Gastroenterology, NHS Greater Glasgow and Clyde, Glasgow, UK"
      ],
      "name": "Maree Pasieka"
    },
    {
      "affiliations": [
        "Gastroenterology, NHS Lothian, Edinburgh, UK"
      ],
      "name": "Ian D Penman"
    },
    {
      "affiliations": [
        "National Endoscopy Training Programme, Clydebank, UK",
        "General Surgery, NHS Ayrshire and Arran, Ayr, UK"
      ],
      "name": "Kevin Robertson"
    },
    {
      "affiliations": [
        "Joint Advisory Group on Gastrointestinal Endoscopy, London, UK",
        "Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK"
      ],
      "name": "Matt Rutter"
    },
    {
      "affiliations": [
        "Gastroenterology, NHS Greater Glasgow and Clyde, Glasgow, UK",
        "National Endoscopy Training Programme, Clydebank, UK"
      ],
      "name": "Adrian J Stanley"
    },
    {
      "affiliations": [
        "Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK"
      ],
      "name": "Richard Tighe"
    },
    {
      "affiliations": [
        "National Endoscopy Training Programme, Clydebank, UK",
        "General Surgery, NHS Lanarkshire, Bothwell, UK"
      ],
      "name": "Michelle Thornton"
    },
    {
      "affiliations": [
        "Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK"
      ],
      "name": "Roland Valori"
    },
    {
      "affiliations": [
        "Gastroenterology, NHS Greater Glasgow and Clyde, Glasgow, UK",
        "National Endoscopy Training Programme, Clydebank, UK"
      ],
      "name": "Jack Winter"
    },
    {
      "affiliations": [
        "Gastroenterology, Sandwell West Birmingham Hospitals NHS Trust, Birmingham, UK",
        "Department of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK"
      ],
      "name": "Nigel John Trudgill"
    }
  ],
  "title": "British Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland guidance on best practice for upper gastrointestinal endoscopy",
  "uid": "018810e3-1d61-511c-a381-466058d04192"
}