The purpose of this Clinical Practice Update (CPU) Expert Review is to provide clinicians with guidance on best practices for performing a high-quality upper endoscopic exam. The best practice advice statements presented herein were developed from a combination of available evidence from published literature, guidelines, and consensus-based expert opinion. No formal rating of the strength or quality of the evidence was carried out, which aligns with standard processes for American Gastroenterological Association (AGA) Institute CPUs. These statements are meant to provide practical, timely advice to clinicians practicing in the United States. This Expert Review was commissioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates (CPU) Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPU Committee and external peer review through standard procedures of . Endoscopists should ensure that upper endoscopy is being performed for an appropriate indication and that informed consent clearly explaining the risks, benefits, alternatives, sedation plan, and potential diagnostic and therapeutic interventions is obtained. These elements should be documented by the endoscopist before the procedure. Endoscopists should ensure that adequate visualization of the upper gastrointestinal mucosa, using mucosal cleansing and insufflation as necessary, is achieved and documented. A high-definition white-light endoscopy system should be used for upper endoscopy instead of a standard-definition white-light endoscopy system whenever possible. The endoscope used for the procedure should be documented in the procedure note. Image enhancement technologies should be used during the upper endoscopic examination to improve the diagnostic yield for preneoplasia and neoplasia. Suspicious areas should be clearly described, photodocumented, and biopsied separately. Endoscopists should spend sufficient time carefully inspecting the foregut mucosa in an anterograde and retroflexed view to improve the detection and characterization of abnormalities. Endoscopists should document any abnormalities noted on upper endoscopy using established classifications and standard terminology whenever possible. Endoscopists should perform biopsies for the evaluation and management of foregut conditions using standardized biopsy protocols. Endoscopists should provide patients with management recommendations based on the specific endoscopic findings (eg, peptic ulcer disease, erosive esophagitis), and this should be documented in the medical record. If recommendations are contingent upon histopathology results (eg, infection, Barrett’s esophagus), then endoscopists should document that appropriate guidance will be provided after results are available. Endoscopists should document whether subsequent surveillance endoscopy is indicated and, if so, provide appropriate surveillance intervals. If the determination of surveillance is contingent on histopathology results, then endoscopists should document that surveillance intervals will be suggested after results are available.

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AGA 高质量上消化道内窥镜临床实践更新：专家评审

本临床实践更新 (CPU) 专家评审的目的是为临床医生提供进行高质量上消化道内窥镜检查的最佳实践指导。本文提出的最佳实践建议声明是根据已发表的文献、指南和基于共识的专家意见的现有证据的结合而制定的。没有对证据的强度或质量进行正式评级，这与美国胃肠病学协会 (AGA) 研究所 CPU 的标准流程一致。这些声明旨在为在美国执业的临床医生提供实用、及时的建议。本专家评审由美国胃肠病学协会 (AGA) 研究所临床实践更新 (CPU) 委员会和 AGA 理事会委托并批准，旨在就对 AGA 会员具有高度临床重要性的主题提供及时指导，并接受了内部同行评审CPU 委员会和外部同行评审通过标准程序进行。内窥镜医师应确保针对适当的适应症进行上消化道内窥镜检查，并获得明确解释风险、益处、替代方案、镇静计划以及潜在的诊断和治疗干预措施的知情同意书。内窥镜医师应在手术前记录这些要素。内窥镜医师应确保上消化道粘膜的充分可视化，必要时使用粘膜清洁和吹气，并进行记录。上消化道内窥镜检查应尽可能使用高清白光内窥镜系统，而不是标准清晰度白光内窥镜系统。用于该程序的内窥镜应记录在程序注释中。上消化道内镜检查时应采用图像增强技术，以提高瘤前期和瘤形成的诊断率。应清楚地描述可疑区域、拍照记录并单独进行活检。内窥镜医师应花费足够的时间以顺行和后屈的角度仔细检查前肠粘膜，以提高异常的检测和表征。内窥镜医师应尽可能使用既定的分类和标准术语记录上消化道内窥镜检查中发现的任何异常情况。内窥镜医师应使用标准化活检方案进行活检，以评估和管理前肠状况。内镜医师应根据具体的内镜检查结果（例如消化性溃疡病、糜烂性食管炎）向患者提供治疗建议，并应记录在病历中。如果建议取决于组织病理学结果（例如感染、巴雷特食管），则内窥镜医师应记录在获得结果后将提供适当的指导。内窥镜医师应记录是否需要进行后续的内窥镜检查监测，如果需要，则提供适当的监测间隔。如果监测的确定取决于组织病理学结果，则内窥镜医师应记录在获得结果后将建议监测间隔。