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Statements: 1 The European Society of Gastrointestinal Endoscopy (ESGE) adheres to the overarching principles of equality of opportunity, fair treatment, nondiscrimination, and diversity of health care professionals. 2 ESGE strongly supports the creation of collaborations within and between national and international endoscopy societies to disseminate the principles of diversity, equality, and inclusion (DEI) in the field of gastrointestinal (GI) endoscopy. 3 ESGE aims to reflect the diversity of its membership in all its scientific and educational activities. 4 ESGE supports the fostering of collaborative work settings that empower all members of the endoscopy team to reach their full potential. 5 ESGE supports international and national endoscopy societies in promoting equitable access to high quality endoscopy training. 6 ESGE recommends the implementation of ergonomic principles in endoscopy units to prevent injuries and to provide adapted workplace conditions for personnel with disabilities and/or special needs. 7 ESGE recommends comprehensive mentorship, that includes diverse backgrounds, and equitable sponsorship for professional development, training, and academic excellence. 8 ESGE recommends that endoscopists actively identify, discuss, and attempt to accommodate reasonable patient preferences and expectations regarding endoscopy procedures. 9 ESGE advocates for educational and awareness campaigns targeting both health care professionals and patients, as well as the adoption of cost-effective health care strategies to address disparities and enhance equity in endoscopy care. 10 ESGE is committed to increasing support for underrepresented scholars and minorities pursuing research in endoscopy. 11 ESGE identifies mentorship and sponsorship as factors that may mitigate the barriers to academic careers for underrepresented endoscopy scholars. 12 ESGE recognizes the need to increase awareness of diversity, equity, and inclusion (DEI) in the field of endoscopy and supports publications on these topics. [ABSTRACT FROM AUTHOR]

Background Gastrointestinal (GI) endoscopy is one of healthcare's main contributors to climate change. We aimed to assess healthcare professionals' attitudes and the perceived barriers to implementation of sustainable GI endoscopy. Methods The LEAFGREEN web-based survey was a cross-sectional study conducted by the European Society of Gastrointestinal Endoscopy (ESGE) Green Endoscopy Working Group. The questionnaire comprised 39 questions divided into five sections (respondent demographics; climate change and sustainability beliefs; waste and resource management; single-use endoscopes and accessories; education and research). The survey was available via email to all active members of the ESGE and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) in March 2023. Results 407 respondents participated in the survey (11% response rate). Most participants (86%) agreed climate change is real and anthropogenic, but one-third did not consider GI endoscopy to be a significant contributor to climate change. Improvement in the appropriateness of endoscopic procedures (41%) and reduction in single-use accessories (34%) were considered the most important strategies to reduce the environmental impact of GI endoscopy. Respondents deemed lack of institutional support and knowledge from staff to be the main barriers to sustainable endoscopy. Strategies to reduce unnecessary GI endoscopic procedures and comparative studies of single-use versus reusable accessories were identified as research priorities. Conclusions In this survey, ESGE and ESGENA members acknowledge climate change as a major threat to humanity. Further improvement in sustainability beliefs and professional attitudes, reduction in inappropriate GI endoscopy, and rational use of single-use accessories and endoscopes are critically required. [ABSTRACT FROM AUTHOR]

Main Statements: This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1 ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2 ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3 ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4 Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5 ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7 ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9 ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10 ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees. [ABSTRACT FROM AUTHOR]

Main statements: All endoscopic procedures are invasive and carry risk. Accordingly, all endoscopists should involve the patient in the decision-making process about the most appropriate endoscopic procedure for that individual, in keeping with a patient's right to self-determination and autonomy. Recognition of this has led to detailed guidelines on informed consent for endoscopy in some countries, but in many no such guidance exists; this may lead to variations in care and exposure to risk of litigation. In this document, the European Society of Gastrointestinal Endoscopy (ESGE) sets out a series of statements that cover best practice in informed consent for endoscopy. These statements should be seen as a minimum standard of practice, but practitioners must be aware of and adhere to the law in their own country. 1 Patients should give informed consent for all gastrointestinal endoscopic procedures for which they have capacity to do so. 2 The healthcare professional seeking consent for an endoscopic procedure should ensure that the patient has the capacity to consent to that procedure. 3 For patients who lack capacity, healthcare personnel should at all times try to engage with people close to the patient, such as family, friends, or caregivers, to achieve consensus on the appropriateness of performing the procedure. 4 Where a patient lacks capacity to provide informed consent, the best interest decision should be clearly documented in the medical record. This should include information about the capacity assessment, reason(s) that the decision cannot be delayed for capacity recovery (or if recovery is not expected), who has been consulted, and where relevant the form of authority for the decision. 5 There should be a systematic and transparent disclosure of the expected benefits and harms that may reasonably affect patient choice on whether or not to undergo any diagnostic or interventional endoscopic procedure. Information about possible alternatives, as well as the consequences of doing nothing, should also be provided when relevant. 6 The information provided on the benefit and harms of an endoscopic procedure should be adapted to the procedure and patient-specific risk factors, and the preferences of the patient should be central to the consent process. 7 The consent discussion should be undertaken by an individual who is familiar with the procedure and its risks, and is able to discuss these in the context of the individual patient. 8 Patients should confirm consent to an endoscopic procedure in a private, unrushed, and non-coercive environment. 9 If a patient requests that an endoscopic procedure be discontinued, the procedure should be paused and the patient's capacity for decision making assessed. If a competent patient continues to object to the procedure, or if a conclusive determination of capacity is not feasible, the examination should be terminated as soon as it is safe to do so. 10 Informed consent should be sufficiently detailed to cover all findings that can be reasonably anticipated during an endoscopic examination. The scope of this consent should not be expanded, nor a patient's implicit consent for additional interventions assumed, unless failure to proceed with such interventions would result in immediate and predictable harm to the patient. [ABSTRACT FROM AUTHOR]

Despite a growing body of evidence, there are limited data regarding the impact of hands-on training on patient safety, with most studies of trainee performance reporting adverse events (AEs) as either a secondary outcome [8][9] or not at all [10][11]. Study groups As there is significant variation in training programs and credentialing across European centers, trainees were defined as endoscopists who had performed fewer than 200 ERCP procedures independently and were working under the direct supervision of an experienced endoscopist (> 1000 ERCP procedures). Graph Introduction Endoscopic retrograde cholangiopancreatography (ERCP) remains one of the most challenging endoscopic procedures to master, as it is both technically demanding and incurs significant risk [1]. [Extracted from the article]

The article discusses the role and focus of young endoscopists in the field of digestive endoscopy. It highlights the importance of education, training, and access to career development opportunities for young endoscopists. The article also emphasizes the need for standardized, high-quality training and credentialing in order to ensure uniformity in the field. It suggests that young endoscopists can contribute to the future of digestive endoscopy by providing input on various key issues, such as training, mobility, education, social media, sub-specialties, artificial intelligence, and ethical values. The article concludes by expressing optimism about the growth and development of the ESGE Young Endoscopists Committee. [Extracted from the article]

In places where access to viral testing is limited or unavailable, we suggest that asymptomatic patients presenting for GI endoscopy with official documentation of full vaccination status or recent recovery from COVID-19 infection should not be obliged to undergo pre-endoscopic viral testing. Methods As in our previous ESGE-ESGENA Position Statements on GI endoscopy and COVID-19 [14][15], a PubMed/MEDLINE search was performed once again, using "severe acute respiratory distress syndrome coronavirus 2", "COVID-19", "endoscopy, digestive system endoscopy", "gastrointestinal endoscopic examination, therapy", "vaccination", and "viral variants" as MeSH terms, between February 1, 2020 and October 15, 2021, to identify relevant publications that could inform this updated Position Statement. This is based on evidence that asymptomatic COVID-19 infection is extremely rare in patients scheduled for GI endoscopy, ranging from 0 to 1.5 % in prevaccination era published series, but still highly dependent on local epidemiology [30]. ESGE (www.esge.com) and ESGENA (www.esgena.org) continue to join forces in this updated Position Statement, to provide ongoing guidance during the pandemic to help assure the highest level of GI endoscopy care and protection against COVID-19 for both our patients and endoscopy unit personnel. [Extracted from the article]

N/A. [ABSTRACT FROM AUTHOR]

Background: Training in advanced endoscopic techniques such as endoscopic retrograde cholangiopancreatography (ERCP) should be driven by key performance measures and standardized competence assessment in order to provide safe and high-quality interventions. We aimed to determine whether the involvement of trainees influences the outcome of the procedure and the incidence of ERCP-related adverse events.Methods: This was an international, multicenter, prospective, observational study conducted at six high- and low-volume centers across Europe between October 2016 and October 2018, and included independent operators and their trainees. Standard report forms documenting indication, trainee involvement, technical outcome, and complications over a 30-day follow-up of consecutive ERCP procedures were included in the analysis. Technical success of the procedure and procedure-related adverse events were compared between procedures in the trainee group and the control group using bivariable and multivariable analysis.Results: 21 trainees and 16 control endoscopists performed 1843 ERCPs during the study period. Trainee involvement in ERCP procedures did not decrease technical success (92.4 % vs. 93.7 %; P = 0.30) or increase the risk of adverse events (14.7 % vs. 14.6 %; P > 0.99). Conversely, there were significantly more moderate or severe adverse events in the control group compared with the trainee group (6.2 % vs. 3.4 %, P = 0.01). On multivariable analysis, only increased bilirubin levels, time to cannulation, and procedure difficulty level increased the risk of any procedure-related adverse event.Conclusion: Trainee involvement in ERCP interventions within a proper teaching setting is safe and does not compromise the success of the procedure. [ABSTRACT FROM AUTHOR]

Whereas APC treats by spreading from the surface to the deeper layers, resection of the mucosal "cap" centered on the angioectasia reveals the true culprit - larger submucosal feeding vessels, which can then be approached directly (Fig. But while APC is a "point-and-shoot" technique, the expertise needed for submucosal treatment of the bleeding caused by resection is altogether different. 1 Treatment effect of argon plasma coagulation (APC) and hot-snare resection on gut layers and the vascular lesion. [Extracted from the article]

Deep biliary cannulation, the cornerstone of ERCP, presents mentors with a conundrum: trainees require a longer time on the papilla to acquire cannulation skills [1], but prolonged cannulation attempts can compromise the procedure and increase the risk for the patient [2], even when experts eventually take over. Trainees were allowed more time, even in failed attempts, as their training progressed, which could reflect mentors trusting their trainees with more responsibilities as they advance in their training. One solution could be a two-tier training system, with novices focusing on acquiring the basic cannulation skills and more advanced training (grade 2 and 3 procedures) being reserved for endoscopists who are already deemed competent in basic cannulation. [Extracted from the article]