Canadian Credentialing Guidelines for Esophagogastroduodenoscopy

A series 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. TRAINING IN EGD Subspecialty gastroenterologistsEndoscopy training for gastroenterologists in Canada typically occurs in the context of accredited residency programs according to the specific objectives described by The Royal College of Physicians and Surgeons of Canada (5).Subspecialty gastroenterology trainees are given graded responsibility as their observed endoscopic skills improve; at the outset, they are assisted by a member of staff and, as their skills improve, they function with progressively greater independence.Training encompasses the technical skills needed to perform EGD, as well as the administration of conscious sedation, discharge planning and patient management. NongastroenterologistsTraining for endoscopists who are not subspecialty gastroenterologists generally occurs over a shorter period of time than the standard subspecialty gastroenterology program in Canada.Under these circumstances, the acquisition of skills for routine EGD may not be accompanied by appropriate experience with advanced procedures, such as endoscopic hemostasis.

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