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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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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9
1.
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]
2.
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]
3.
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]
4.
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]
5.
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]
6.
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]
7.
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]
8.
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]
9.
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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UEG Mistakes In Articles
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Mistakes in the management of hepatocellular carcinoma and how to avoid them

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Summary

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9
1.
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]
2.
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]
3.
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]
4.
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]
5.
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]
6.
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]
7.
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]
8.
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]
9.
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

Liver cancer is the sixth most common cancer and the third leading cause of cancer-related death. Hepatocellular carcinoma (HCC) accounts for about 90% of cases and mostly arises in chronic liver disease, especially cirrhosis. Viral hepatitis remains a leading cause, but alcohol-related disease and MASLD are rising. With immune checkpoint inhibitors transforming HCC management, it is timely to highlight common mistakes across screening, staging, diagnosis and treatment.

Topics

Digestive Oncology Hepatobiliary

Published

2026

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UEG Standards and Guidelines
Clinical Practice Guideline
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European Interdisciplinary Guidelines on Pain Management in Acute Pancreatitis: UEG, EPC, EDS, ESDO, EAGEN, ESPGHAN, ESGAR, and ESPCG Evidence-Based Recommendations

Sanjay Pandanaboyana

Summary

AI Generated

Summary is not available for this content yet.

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Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Guideline

ABSTRACT

Pain is often the presenting symptom of acute pancreatitis (AP) and has a prognostic significance, with poorly treated pain affecting patient outcomes. Despite this, there are currently no international recommendations for pain management in patients admitted with AP. This current guideline was developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. Nine working groups were formed to develop statements on pain management in AP from admission to discharge. After systematic literature reviews, the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted using three rounds of Delphi method. The guidelines concluded that acute postoperative pain management guidelines are applicable for treating acute pain due to AP. The numerical rating scale is preferred for pain assessment because of better compliance. Opioids currently form the cornerstone of severe pain management. Potent opioids such as buprenorphine and pentazocine provide superior pain relief over non-opioid medications and decrease the need for rescue analgesia. Current evidence does not consistently demonstrate harm from opioids in AP. In patients with severe pain, safety concerns should not delay the timely use of opioids to ensure adequate pain management. Specific recommendations concerning the use of epidural analgesia, acupuncture and management of pain in the paediatric population and during pregnancy are provided based on evidence and expert opinions. Finally, the unmet needs for future research were discussed and proposed.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

United European Gastroenterology Journal, 2026

Published

2026

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UEG Podcast Episode
UEG Podcast
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Abstract

Topics

Digestive Oncology Endoscopy Oesophagus

Published

2025

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UEG Standards and Guidelines
Clinical Practice Guideline
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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

2026

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UEG Podcast Episode
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Nutrition in coeliac disease for a clinician with Cristian Costas

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Abstract

Topics

Small Intestine & Nutrition

Published

2026

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UEG Mistakes In Articles
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Mistakes in the evaluation and management of dysphagia and how to avoid them

Amir Mari, Edoardo Vincenzo Savarino, Jawad Hindy

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References

Mistakes
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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]
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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]
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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]
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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]
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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]
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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]
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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]
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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]
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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]
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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]
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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]
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Abstract

Dysphagia is a common symptom with a broad differential diagnosis encompassing structural, inflammatory, infectious, functional, neurological, and oesophageal motility disorders. Despite major advances in endoscopy, high-resolution manometry (HRM), impedance planimetry (EndoFLIP), and swallowing assessment, diagnostic delays and inappropriate management remain common. In most cases, these shortcomings reflect errors in clinical reasoning rather than limitations of available investigations.1

Increasing recognition of eosinophilic oesophagitis (EoE), functional dysphagia, opioid-induced oesophageal dysfunction, and complex motility disorders has further emphasised the importance of integrating clinical history with endoscopic, histological, physiological, and complementary radiological findings. Optimal evaluation increasingly requires multidisciplinary collaboration involving gastroenterologists, otolaryngologists, neurologists, speech–language pathologists, radiologists, and surgeons.1–5

In this article, we discuss the most common mistakes in the evaluation and management of dysphagia and provide practical, evidence-based recommendations to help clinicians avoid them.

Dysphagia is a common symptom with a broad differential diagnosis encompassing structural, inflammatory, infectious, functional, neurological, and oesophageal motility disorders. Despite major advances in endoscopy, high-resolution manometry (HRM), impedance planimetry (EndoFLIP), and swallowing assessment, diagnostic delays and inappropriate management remain common. In most cases, these shortcomings reflect errors in clinical reasoning rather than limitations of available investigations.1

Increasing recognition of eosinophilic oesophagitis (EoE), functional dysphagia, opioid-induced oesophageal dysfunction, and complex motility disorders has further emphasised the importance of integrating clinical history with endoscopic, histological, physiological, and complementary radiological findings. Optimal evaluation increasingly requires multidisciplinary collaboration involving gastroenterologists, otolaryngologists, neurologists, speech–language pathologists, radiologists, and surgeons.1–5

In this article, we discuss the most common mistakes in the evaluation and management of dysphagia and provide practical, evidence-based recommendations to help clinicians avoid them.

Topics

Neurogastroenterology & Motility

Published

2026

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