Canadian credentialing guidelines for esophagogastroduodenoscopy

Acquisition of the nontechnical components of competence for EGD requires a training program that should generally last a minimum of six to 12 months. Technical competence for EGD can be assessed after 150 procedures, acknowledging that the completion of a specified number of procedures does not guarantee competence. It is recommended that documentation of competence should be based on the completion of at least 100 unassisted procedures. Competent endoscopists should be able to intubate the second part of the duodenum in virtually all cases (35); a methodical, careful inspection of the upper gastrointestinal tract should be documented and photodocumentation of duodenal intubation and retroflexion in the stomach is encouraged for quality assurance purposes. There are no data on optimal inspection or withdrawal times, but the need for multiple biopsies in, for example, Barrett's esophagus surveillance (15,16,35) may prolong the procedure. Competence in EGD requires the ability to perform all standard diagnostic and therapeutic interventions when indicated. At least 20 supervised, unassisted procedures should be performed for the management of each of nonvariceal hemorrhage, variceal hemorrhage and esophageal stricture requiring dilation (33), as a basis for documenting competence. It is likely that success rates, for EGD will be greater for practitioners who perform at least 100 to 200 procedures annually. Immediate complication rates for EGD should be less than one in 1000 for all patients (13,36-41). Given the rapid advances that are occurring in endoscopy and the need to maintain endoscopic privileges, a formalized system of ongoing training and monitoring is warranted. Institutions that grant privileges for EGD should be encouraged to develop endoscopic reporting mechanisms and databases so that practitioners may monitor the quality of their practice and effect improvements if they identify deficiencies (60,61). © 2008 Pulsus Group Inc. All rights reserved.