Mistakes in gastroscopy and how to avoid them

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Mistakes in gastroscopy and how to avoid them

Arne Kandulski, Jochen Weigt

Summary

AI Generated

This article addresses common pitfalls and misdiagnoses in upper GI-endoscopy performance, emphasizing that gastroscopy should not be treated as routine despite being frequently performed.

Several pitfalls in gastroscopy performance can cause serious problems or misdiagnoses, including struggles in accurately describing and classifying abnormal findings.
Key technical concerns include correct endoscope introduction technique and proper investigation of the mucosal surface using available imaging modalities such as virtual chromoendoscopy or magnification.
Critical decisions must be made immediately during endoscopy, including which classification systems to use and whether to take biopsies, as biopsies may interfere with later endoscopic resection.
The article highlights the most common clinically relevant mistakes in gastroscopy and provides guidance on how to avoid them, intended for gastroenterologists performing upper endoscopy.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9

Pouw RE, Barret M, Biermann K, Bisschops R, Czakó L, Gecse KB, u. a. Endoscopic tissue sampling - Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. November 2021;53(11):1174–88 [Link]

Bisschops R, Areia M, Coron E, Dobru D, Kaskas B, Kuvaev R, u. a. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. September 2016;48(9):843–64 [Link]

Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. Oktober 1996;20(10):1161–81 [Link]

Klöppel G, Couvelard A, Perren A, Komminoth P, McNicol AM, Nilsson O, u. a. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: towards a standardized approach to the diagnosis of gastroenteropancreatic neuroendocrine tumors and their prognostic stratification. Neuroendocrinology. 2009;90(2):162–6 [Link]

Yoshifuku Y, Sanomura Y, Oka S, Kuroki K, Kurihara M, Mizumoto T, u. a. Clinical Usefulness of the VS Classification System Using Magnifying Endoscopy with Blue Laser Imaging for Early Gastric Cancer. Gastroenterol Res Pract. 2017;2017:3649705 [Link]

Minami H, Isomoto H, Inoue H, Akazawa Y, Yamaguchi N, Ohnita K, u. a. Significance of background coloration in endoscopic detection of early esophageal squamous cell carcinoma. Digestion. 2014;89(1):6–11. [Link]

Abdelhafez M, Phillip V, Hapfelmeier A, Sturm V, Elnegouly M, Dollhopf M, u. a. Comparison of cap-assisted endoscopy vs. side-viewing endoscopy for examination of the major duodenal papilla: a randomized, controlled, noninferiority crossover study. Endoscopy. Mai 2019;51(5):419–26 [Link]

Shi X, Luo H, Ning B, Wang X, Tao Q, Liang S, u. a. Effect of cap-assisted esophagogastroduodenoscopy on examination of the major duodenal papilla: a noninferior, randomized controlled trial. Endoscopy. Mai 2019;51(5):427–35. [Link]

Patel VD, Thompson WK, Lapin BR, Goldstein JL, Yen EF. Screening Colonoscopy Withdrawal Time Threshold for Adequate Proximal Serrated Polyp Detection Rate. Dig Dis Sci. November 2018;63(11):3084–90 [Link]

10.

avricka SR, Sulz MC, Degen L, Rechner R, Manz M, Biedermann L, u. a. Monitoring colonoscopy withdrawal time significantly improves the adenoma detection rate and the performance of endoscopists. Endoscopy. März 2016;48(3):256–62 [Link]

11.

Park JM, Huo SM, Lee HH, Lee BI, Song HJ, Choi MG. Longer Observation Time Increases Proportion of Neoplasms Detected by Esophagogastroduodenoscopy. Gastroenterology. August 2017;153(2):460-469.e1. [Link]

12.

Teh JL, Tan JR, Lau LJF, Saxena N, Salim A, Tay A, u. a. Longer examination time improves detection of gastric cancer during diagnostic upper gastrointestinal endoscopy. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. März 2015;13(3):480-487.e2. [Link]

13.

Kawamura T, Wada H, Sakiyama N, Ueda Y, Shirakawa A, Okada Y, u. a. Examination time as a quality indicator of screening upper gastrointestinal endoscopy for asymptomatic examinees. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. Juli 2017;29(5):569–75 [Link]

14.

Sato T, Kato Y, Matsuura M, Gagner M. Significance of palisading longitudinal esophagus vessels: identification of the true esophagogastric junction has histopathological and oncological considerations. Dig Dis Sci. November 2010;55(11):3095–101. [Link]

15.

Renna F, Martins M, Neto A, Cunha A, Libânio D, Dinis-Ribeiro M, u. a. Artificial Intelligence for Upper Gastrointestinal Endoscopy: A Roadmap from Technology Development to Clinical Practice. Diagnostics. 21. Mai 2022;12(5):1278. [Link]

16.

Azar C, Jamali F, Tamim H, Abdul-Baki H, Soweid A. Prevalence of endoscopically identified heterotopic gastric mucosa in the proximal esophagus: endoscopist dependent? J Clin Gastroenterol. Juni 2007;41(5):468–71. [Link]

17.

Yin Y, Li H, Feng J, Zheng K, Yoshida E, Wang L, u. a. Prevalence and Clinical and Endoscopic Characteristics of Cervical Inlet Patch (Heterotopic Gastric Mucosa): A Systematic Review and Meta-Analysis. J Clin Gastroenterol. 1. März 2022;56(3):e250–62. [Link]

18.

Ho SH, Uedo N, Aso A, Shimizu S, Saito Y, Yao K, u. a. Development of Image-enhanced Endoscopy of the Gastrointestinal Tract: A Review of History and Current Evidences. J Clin Gastroenterol. April 2018;52(4):295–306 [Link]

19.

Chung SJ, Kim D, Song JH, Kang HY, Chung GE, Choi J, u. a. Comparison of detection and miss rates of narrow band imaging, flexible spectral imaging chromoendoscopy and white light at screening colonoscopy: a randomised controlled back-to-back study. Gut. Mai 2014;63(5):785–91. [Link]

20.

P, Zhang W, Sun X, Liu Y, Nong B. Comparison of linked color imaging and white-light colonoscopy for detection Min M, Deng of colorectal polyps: a multicenter, randomized, crossover trial. Gastrointest Endosc. Oktober 2017;86(4):724–30 [Link]

21.

Zhao Z, Yin Z, Wang S, Wang J, Bai B, Qiu Z, u. a. Meta-analysis: The diagnostic efficacy of chromoendoscopy for early gastric cancer and premalignant gastric lesions. J Gastroenterol Hepatol. September 2016;31(9):1539–45. [Link]

22.

Kikuste I, Marques-Pereira R, Monteiro-Soares M, Pimentel-Nunes P, Areia M, Leja M, u. a. Systematic review of the diagnosis of gastric premalignant conditions and neoplasia with high-resolution endoscopic technologies. Scand J Gastroenterol. Oktober 2013;48(10):1108–17 [Link]

23.

Pimentel-Nunes P, Dinis-Ribeiro M, Soares JB, Marcos-Pinto R, Santos C, Rolanda C, u. a. A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions. Endoscopy. März 2012;44(3):236–46 [Link]

24.

Dias-Silva D, Pimentel-Nunes P, Magalhães J, Magalhães R, Veloso N, Ferreira C, u. a. The learning curve for narrow-band imaging in the diagnosis of precancerous gastric lesions by using Web-based video. Gastrointest Endosc. Juni 2014;79(6):910–20; quiz 983-e1, 983.e4. [Link]

25.

Esposito G, Pimentel-Nunes P, Angeletti S, Castro R, Libânio D, Galli G, u. a. Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study. Endoscopy. Juni 2019;51(6):515–21 [Link]

26.

Shu X, Wu G, Zhang Y, Wang Y, Zheng Y, Guo Q, u. a. Diagnostic value of linked color imaging based on endoscopy for gastric intestinal metaplasia: a systematic review and meta-analysis. Ann Transl Med. März 2021;9(6):506 [Link]

27.

Zhang G, Zheng J, Zheng L, Yu S, Jiang C, Lin W, u. a. Gastric intestinal metaplasia assessment between linked color imaging based on endoscopy and pathology. Scand J Gastroenterol. Januar 2021;56(1):103–10 [Link]

28.

Subramaniam S, Kandiah K, Schoon E, Aepli P, Hayee B, Pischel A, u. a. Development and validation of the international Blue Light Imaging for Barrett’s Neoplasia Classification. Gastrointest Endosc. Februar 2020;91(2):310–20. [Link]

29.

de Groof AJ, Fockens KN, Struyvenberg MR, Pouw RE, Weusten BLAM, Schoon EJ, u. a. Blue-light imaging and linked-color imaging improve visualization of Barrett’s neoplasia by nonexpert endoscopists. Gastrointest Endosc. Mai 2020;91(5):1050–7. [Link]

30.

Ueyama H, Yao T, Akazawa Y, Hayashi T, Kurahara K, Oshiro Y, u. a. Gastric epithelial neoplasm of fundic-gland mucosa lineage: proposal for a new classification in association with gastric adenocarcinoma of fundic-gland type. J Gastroenterol. September 2021;56(9):814–28. [Link]

31.

Abraham SC, Nobukawa B, Giardiello FM, Hamilton SR, Wu TT. Fundic gland polyps in familial adenomatous polyposis: neoplasms with frequent somatic adenomatous polyposis coli gene alterations. Am J Pathol. September 2000;157(3):747–54 [Link]

Abstract

Upper GI-endoscopy is one of gastroenterology's most frequently performed diagnostic and interventional methods. Even though gastroscopy is believed to be a routine investigation - which is the greatest mistake of all - several pitfalls in performance can cause serious problems or misdiagnoses. Struggles in accurately describing and classifying abnormal findings can occur and concern the correct basic technique of endoscope introduction, and the correct way of investigating the mucosal surface in total, with several available imaging modalities such as virtual chromoendoscopy or magnification. Which classification systems should be used? The decision to perform additional workup needs to be made immediately during the ongoing endoscopy. Is it necessary to take biopsies, or should it even be avoided due to potential interference with a later endoscopic resection? This article answers the questions, highlights the most common mistakes with clinical relevance and expands on how to avoid them.

Topics

Endoscopy

Citation

Weigt J and Kandulski A. Mistakes in gastroscopy and how to avoid them. UEG Education 2022; 22: 21–25.

Published

2022

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9

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Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

Laura Leeuwenburgh

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Guideline

ABSTRACT

Background

Pancreatic cancer remains one of the most lethal cancers despite extensive efforts and research conducted over the past decades. To effectuate groundbreaking improvements in pancreatic cancer treatment, interdisciplinary and international collaboration is essential. Evidence-based guidelines, including state-of-the-art evidence and expert opinion, are crucial to guide medical specialists, researchers, and patients, especially on issues where consensus is still lacking. This article describes the methodological protocol for the development of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer. The guideline aims to identify current knowledge gaps on pancreatic cancer management, develop questions based on these knowledge gaps, and answer these questions with evidence-based recommendations supplemented, when evidence is lacking, with expert advice for treatment and future research.

Methods

This guideline development protocol is developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The process is structured into six stages: First, 13 theme-based multidisciplinary working groups are established, comprising representatives from 30 European medical and patient societies. Second, these working groups identify the most relevant current knowledge gaps on pancreatic cancer within their theme and formulate key questions. Third, the available evidence to answer these key questions is obtained through systematic reviews and the certainty of evidence is assessed using the GRADE approach. Fourth, recommendations are developed based on the available evidence. Fifth, all participants reach consensus on the recommendations through a modified Delphi process. Sixth, the recommendations are discussed during an open conference, including an external validation committee.

Discussion

This methodological protocol of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer is designed to identify key knowledge gaps across 13 themes and formulate evidence-based recommendations. This guideline initiative unites 30 European medical and patient societies for pancreatic cancer.

Summary

Methodological protocol of an international multi-disciplinary guideline involving 30 European medical and patient societies.
This protocol highlights the six stages of the guideline development process, adhering to the key principles of the GRADE methodology, and thereby aims to maximise transparency and methodological quality.
With addressing knowledge gaps, this guideline will uncover areas with limited evidence. A priority rating for research needs, based on a survey, will be established, highlighting areas where future research is most warranted.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

Clinical and Public Health Guidelines 3 (2026)

Published

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