Quality indicators common to all GI endoscopic procedures.

Winning the Colonoscopy Revaluation Delay

GI endoscopic reprocessing: maintaining public confidence in the face of decreasing reimbursements

Faigel, Douglas O. M.D., ASGE Co-Chair.; Pike, Irving M. M.D., ACG Co-Chair.; Baron, Todd H. M.D.; Chak, Amitabh M.D.; Cohen, Jonathan M.D.; Deal, Stephen E. M.D.; Hoffman, Brenda M.D.; Jacobson, Brian C. M.D., M.P.H.; Mergener, Klaus M.D., Ph.D.; Petersen, Bret T. M.D.; Petrini, John L. M.D.; Rex, Douglas K. M.D.; Safdi, Michael A. M.D. Author Information

The ASGE guidelines for the appropriate use of colonoscopy in an open access system

Background: In the setting of endoscopy in an anticoagulated patient, the endoscopist must assess the risk of complications related to intercurrent bleeding or thrombosis and plan the endoscopic procedure accordingly....

ASGE guideline on screening for pancreatic cancer in individuals with genetic susceptibility: summary and recommendations

The ASGE guidelines for the appropriate use of upper gastrointestinal endoscopy in an open access system

Introduction Traumatic brain injury (TBI) remains a critical challenge in polytrauma management, with mortality frequently attributed to the brain injury itself. While current prognostic models like IMPACT provide valuable insights, they inadequately capture outcome variability. This study investigates whether incorporating the American Society of Anesthesiologists (ASA) score and Trauma and Injury Severity Score (TRISS) as additional metrics improves long-term outcome prediction in moderate-to-severe TBI (msTBI) patients. Method We retrospectively analyzed data from 720 msTBI patients treated between 2005-2021. Patient information—including ASA score, Glasgow Coma Scale (GCS), age, and polytrauma indicators—was collected from institutional trauma registries. The primary endpoint was 1-year Glasgow Outcome Scale (GOS), with 90-day mortality as a secondary measure. Logistic regression assessed the predictive values of ASA score and TRISS as independent additions to established prognostic frameworks. Result Among the cohort, 35% presented with polytrauma. Unfavorable outcomes (GOS 1-3) occurred in 51% of cases, with a 90-day mortality rate of 19%. Key outcome predictors included age, ASA score, GCS, TRISS, and pupillary reaction. Adding the ASA score to the prognostic model significantly enhanced predictive performance. Discussion Our findings suggest that TRISS retains critical prognostic metrics even in TBI populations, and that pre-injury health—as measured by the ASA score—is independently associated with outcomes. This indicates that factors beyond age play a crucial role in patient prognosis. With further validation, these insights could support more precise resource allocation and tailored clinical management, although additional prospective research is needed to confirm these results.

Objective. The aim of the present study was to compare the ability of four clinical prediction rules to predict adverse outcome in perforated peptic ulcer (PPU): the Boey score, the American Society of Anesthesiologists (ASA) score, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and the sepsis score. Material and methods. Design: an observational multicenter study. Participants and settings: a total of 117 patients surgically treated for PPU between 1 January 2008 and 31 December 2009 in seven gastrointestinal departments in Denmark were included. Pregnant and breastfeeding women, non-surgically treated patients, patients with malignant ulcers, and patients with perforation of other organs were excluded. Primary outcome measure: 30-day mortality rate. Statistical analysis: the ability of four clinical prediction rules to distinguish survivors from non-survivors (discrimination ability) was evaluated by the area under the receiver operating characteristic curve (AUC), positive predictive values (PPVs), negative predictive values (NPVs), and adjusted relative risks. Results. Median age (range) was 70 years (25–92 years), 51% of the patients were females, and 73% of the patients had at least one co-existing disease. The 30-day mortality proportion was 17% (20/117). The AUCs: the Boey score, 0.63; the sepsis score, 0.69; the ASA score, 0.73; and the APACHE II score, 0.76. Overall, the PPVs of all four prediction rules were low and the NPVs high. Conclusions. The Boey score, the ASA score, the APACHE II score, and the sepsis score predict mortality poorly in patients with PPU.

Aim: In the literature, studies comparing the preferred anesthesia methods and related parameters in obstetric anesthesia during the pandemic period with the pre-pandemic period are limited. I n this study, primarily in patients who gave birth by cesarean section before and during the COVID-19 (Coronavirus disease 19) pandemic; It was aimed to evaluate the anesthesia method, postoperative complications, length of hospital stay, clinical urgency of the patients and ASA (American Society of Anesthesiologists) scores. In addition, in patients who underwent cesarean section with positive and negative PCR (Polymerase Chain Reaction) tests during the COVID-19 pandemic; It was aimed to evaluate the anesthesia method, postoperative complications, hospital stay, clinical urgency of the cases and ASA scores. Material and Method: In this retrospective, single-center study, we noted down and compared types of cesarean section (elective or emergency), anesthesia techniques (spinal, spinal+epidural, or general anesthesia), and patients’ ages, ASA scores, PCR test results, postoperative complications (e.g., pneumonia, excessive postpartum bleeding), and lengths of hospital stay. Results: We carried out this study with the data of 2,406 women, 1,458 of whom gave birth before the pandemic. The findings revealed that the rate of developing complications, the length of hospital stay, the number of patients with an ASA score of 3 and above, and the use of spinal anesthesia significantly increased during the pandemic. Moreover, 182 women were COVID-19-positive among a total of 948 applicants during the pandemic. Although the ASA scores and complication rates were significantly higher among those with a positive PCR test result, the length of hospital stay was similar between the patients by their PCR test results. Conclusion: Our findings revealed a significant decrease in spinal + epidural anesthesia, which was frequently adopted before, in cases with cesarean section during the pandemic. Spinal anesthesia was mostly used alone. Despite increased complication rates in PCR-positive patients with higher ASA scores undergoing cesarean section, we concluded no significant change in the length of hospital stay. In cases of increased risk of infection and transmission (e.g., pandemic), neuraxial blocks may be preferred as an anesthesia technique to minimize the risk of infection in emergency obstetric operations. It should also be noted that the risk of developing postoperative complications always be high during pandemics.

Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update

In 2009 the American Society for Gastrointestinal Endoscopy (ASGE) guidelines advised that both aspirin and NSAIDs be continued prior to low-risk gastrointestinal endoscopic procedures. We sought to determine physician knowledge regarding these guidelines. A survey questionnaire was developed based on the ASGE guidelines. Physicians were queried about whether they would continue/stop aspirin in a patient with cardiac disease and in a patient taking NSAIDs for arthritis whether they would continue/stop NSAIDs prior to endoscopy. The survey was administered at three academic medical centers. Demographic information: level of training, board certification, teaching trainees, percentage of time in clinical practice, year of medical school graduation, and location of medical school were all reviewed. The primary outcome was number of questions answered correctly and predictors of correct responses. The survey was administered to 941 participants with 12 declining to participate, while 80% (740/929) of the subjects completed the survey; 20% (150/740) respondents answered both questions correctly and 42% (310/740) answered one question correctly. There was no significant difference between institutions (p = 0.6) or between attendings and trainees (p = 0.75). Multivariate predictors of correct answers were self-reported familiarity with the guideline (-0.029; 95% CI -0.003 to -0.056, p < 0.031), level of training (0.050; 95% CI 0.012-0.088, p = 0.010), and specialty (0.108; 95% CI 0.058-0.159, p < 0.0001). Finally, there was an inverse, linear relationship between postgraduate year and percent questions correct. Physician knowledge of guidelines regarding the use of aspirin and NSAIDs prior to endoscopy is suboptimal. Interventions are necessary to improve knowledge of the current pre-procedure guidelines.

The strategies based on H. pylori test enjoyed similar symptom resolution, but reduced endoscopic workload and lower 1-yr total costs compared with empirical antisecretory therapy.

Resection of pancreatic neuroendocrine tumors is associated with a high risk of clinically relevant postoperative complications. This study aimed to evaluate and analyze the relationship between selected preoperative risk factors and the occurrence of clinically relevant early postoperative complications, including pancreatic fistulas, after distal pancreatic resections for neuroendocrine tumors. The analysis included 78 patients who underwent surgery for neuroendocrine tumors of the body or tail of the pancreas. A retrospective analysis was carried out regarding age, sex, comorbidities, preoperative C-reactive protein (CRP) levels, American Society of Anesthesiologists (ASA) score, tumor size, and Wirsung's duct diameter as measured on preoperative computed tomography (CT) scans of the abdomen. The severity of postoperative complications was assessed using the Clavien-Dindo classification, while the International Study Group on Pancreatic Fistula (ISGPF) classification was utilized to evaluate pancreatic fistulas. Pancreatic fistula was the most common complication and occurred in 42 cases (55.3%). A significant relationship was found between the ASA score and complication severity according to the Clavien-Dindo classification (p = 0.01). Multivariate analyses indicated associations between the occurrence of pancreatic fistula and male sex (OR = 0.17, p = 0.06), age (OR = 0.86, p < 0.01), preoperative CRP level (OR = 1.05, p = 0.01), and ASA score (OR = 125.97, p < 0.01). No significant correlation was identified between tumor size or Wirsung's duct diameter and the occurrence of clinically relevant postoperative complications or pancreatic fistulas (p > 0.05). The ASA score correlates with the severity of postoperative complications as assessed by the Clavien-Dindo classification. The risk factors for developing B and/or C pancreatic fistulas include age, male sex, elevated preoperative CRP levels, and higher ASA scores.

A patient's needs at discharge, particularly the need for nursing facility placement, may affect hospital length of stay and health care costs. The association between age and disposition after microvascular reconstruction of the head and neck has yet to be reported in the literature. To determine whether elderly patients are more likely to be discharged to a nursing or other care facility as opposed to returning home after microvascular reconstruction of the head and neck. From January 1, 2001, through December 31, 2010, patients undergoing microvascular reconstruction at an academic medical center were identified and their medical records systematically reviewed. During the study period, 457 patients were identified by Current Procedural Terminology codes for microvascular free tissue transfer for a head and neck defect regardless of cause. Seven patients were excluded for inadequate data on the postoperative disposition or American Society of Anesthesiologists (ASA) score. A total of 450 were included for analysis. Demographic and surgical data were collected, including the patient age, ASA score, and postoperative length of stay. These variables were then compared between groups of patients discharged to different posthospitalization care facilities. The mean age of participants was 59.1 years. Most patients (n = 386 [85.8%]) were discharged home with or without home health services. The mean age of those discharged home was 57.5 years; discharge to home was the reference for comparison and odds ratio (OR) calculation. For those discharged to a skilled nursing facility, mean age was 67.1 years (OR, 1.055; P < .001). Mean age of those discharged to a long-term acute care facility was 71.5 years (OR, 1.092; P = .002). Length of stay also affected the disposition to a skilled nursing facility (OR, 1.098), as did the ASA score (OR, 2.988). Elderly patients are less likely to be discharged home after free flap reconstruction. Age, ASA score, and length of stay are independent factors for discharge to a nursing or other care facility.