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Improving quality in upper gastrointestinal endoscopy
  1. Sabina Beg1,
  2. Matthew Banks2,3
  1. 1 Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Gastroenterology, UCL, London, UK
  3. 3 Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Matthew Banks, Gastroenterology, UCL, London, London, UK; Matthew.Banks{at}

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Oesophagogastroduodenoscopy (OGD) remains the gold standard investigative modality for pathology of the upper gastrointestinal (UGI) tract. Training in endoscopy in the UK is delivered using an apprenticeship style model, with oversight and certification of competence undertaken by the Joint Advisory Group (JAG) of GI endoscopy. Accreditation for independent practice requires the achievement of certain standards followed by formal assessment. This is a robust and well-understood process, so do we need further guidance to determine how we enable our trainees to achieve these milestones?

In formalising standards within the field of endoscopy and developing tools to assess these, JAG has become synonymous with quality, with the concept of monitoring key performance indicators and using Direct Observation of Procedural Skills (DOPS) assessments having been adopted internationally.1 The current focus on training in UGI endoscopy comes at a time when there is increased awareness of the potentially modifiable shortcomings of OGD, such as 11.3% of those diagnosed with UGI malignancy having had a normal gastroscopy in the 3 years prior, the so-called post-OGD upper gastrointestinal cancer rate (POUGIC).2 This is coupled with advances in both technology and technique, which has resulted in a paradigm shift from the aim of endoscopy being to diagnose overt cancers, to detecting early pathology potentially amendable to organ-sparing endoscopic therapy. There is an acceptance that quality in OGD has lagged behind colonoscopy for over a decade, which is reflected in the large discrepancy between POUGIC and postcolonoscopy colorectal cancer rates, likely due to the greater complexity of pathology characterisation …

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  • Contributors Both authors contributed equally to the commentary.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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