Quality standards in upper gastrointestinal endoscopy in a tertiary care centre

Objective: Upper Gastrointestinal Endoscopy (UGIE) is a minimally invasive diagnostic modality which is used widely in Sri Lanka. We have noted a deficiency in maintaining quality standards during the procedure and documentation. The aim of this study was to assess the degree to which UGIE performed in a tertiary care unit in a developing country maintains quality standards compared to established guidelines. Material and Methods: Data of 68 patient’s UGIE assessed prospectively over 6 months, is compared with the quality standards (16 selected components) from the British Society of Gastroenterology (BSG) and American Society of Gastrointestinal Endoscopy (ASGE) quality standards. Our quality is graded as poor, fair, moderate, good or excellent in agreement, relative to the BSG/ASGE standards, using kappa values. Results: Among the 16 components of quality standards assessed only 4 (kappa >.0.81) were in excellent agreement. Three (kappa >0.0 and <0.20) were fair. One (kappa > 0.41 and < 0.60) was moderate. Another 4 (kappa >0.61 and <0.80) were good. Five components were poor (kappa <0) Conclusion: Most of the accepted quality standards are not adequately maintained during UGIE procedures. Following a standard protocol and filling a pro-forma would increase the quality of UGIE in managing patients with upper gastrointestinal pathologies. A pro-forma would be developed taking in to consideration the components required, to be used in a follow up study.