This is the current release of the guideline.

Definitions for the grades of recommendation (1A to 3) are provided at the end of the "Major Recommendations."

1. Routine testing to include coagulation studies, chest x-ray films, electrocardiogram (ECG), blood cross-matching, hemoglobin level, urinalysis, and chemistry tests are not recommended before endoscopy. (1C)
2. All women of child-bearing age should be queried about the possibility of being pregnant. Pregnancy testing may be considered in women of child-bearing age unless there is a history of total hysterectomy, bilateral tubal ligation, or absent menses for 1 year (menopause). (3)
3. Consider testing based on the perceived level of risk as determined by the medical history and physical examination as follows:
   1. Coagulation studies: Active bleeding, known or clinically suspected bleeding disorder, medication risk (e.g., anticoagulant use, prolonged antibiotics), prolonged biliary obstruction, history of abnormal bleeding (e.g., easy bruisability, epistaxis, bleeding after dental procedures), history of liver disease, malabsorption (e.g., sprue), malnutrition, or other conditions associated with acquired coagulopathies (e.g., leukemia) (3)
   2. Chest x-ray film: Advanced age, significant smoking history, recent upper respiratory tract infection, and severe or decompensated cardiopulmonary disease (3)
   3. ECG: Advanced age and comorbid illness (e.g., heart disease, arrhythmia, diabetes, hypertension, and electrolyte disturbances), particularly for symptomatic patients undergoing more invasive and prolonged procedures (3)
   4. Blood cross-matching: Blood transfusion considered likely (3)
   5. Hemoglobin/hematocrit: Existing anemia, risk factors for bleeding, high risk for adverse events with significant bleeding, advanced liver disease or hematologic disorder, endoscopic procedures associated with a high risk of bleeding complications (3)
   6. Urinalysis: There are no clear indications for obtaining a urinalysis before endoscopy. (1C)
   7. Chemistry testing: Significant endocrine, renal, or hepatic dysfunction and when taking medications that may further impair function (3)

Definitions:

Adapted from Guyatt G, Sinclair J, Cook D, et al. Moving from evidence to action: grading recommendations—a qualitative approach. In: Guyatt G, Rennie D, editors. Users' guides to the medical literature. Chicago: AMA Press; 2002. p. 599-608.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2008 Nov

American Society for Gastrointestinal Endoscopy - Medical Specialty Society

American Society for Gastrointestinal Endoscopy

Standards of Practice Committee

Committee Members: Michael J. Levy, MD; Michelle A. Anderson, MD; Todd H. Baron, MD, Chair; Subhas Banerjee, MD; Jason A. Dominitz, MD, MHS; S. Ian Gan, MD; M. Edwyn Harrison, MD; Steven O. Ikenberry, MD; Sanjay Jagannath, MD; David Lichtenstein, MD; Bo Shen, MD; Robert D. Fanelli, MD, SAGES Representative; Leslie Stewart, RN, SGNA Representative; Khalid Khan, MD, NAPSGHAN Representative

Not stated

Society of American Gastrointestinal and Endoscopic Surgeons - Medical Specialty Society

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI Institute on June 12, 2009.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.