This is the current release of the guideline.

Diseases or conditions requiring gastrointestinal endoscopy

Diagnosis
Evaluation
Management
Risk Assessment
Screening

Gastroenterology
Surgery

Physicians

To provide guidance regarding routine laboratory testing before endoscopic procedures

Patients undergoing gastrointestinal endoscopy

Routine Pre-Endoscopy Laboratory Testing*

1. Coagulation studies:
   • Prothrombin time (PT)
   • INR (international normalized ratio)
   • Partial thromboplastin time (PTT)
   • Platelet time
   • Bleeding time
2. Chest x-ray
3. Electrocardiogram (ECG)
4. Blood cross-matching
5. Hemoglobin/hematocrit
6. Urinalysis
7. Pregnancy testing
8. Serum chemistry testing

*Note: No evidence supports routine preprocedure testing; therefore, none of these tests is recommended routinely (see "Major Recommendations" section for procedures to perform on a selective basis).

• Incidence of abnormal laboratory test results
• Correlation of abnormal laboratory test results to procedural outcome

Searches of Electronic Databases

MEDLINE and PubMed databases were used to search publications related to endoscopy by using the key words "endoscopy" and "laboratory" with each of the following: "preanesthesia," "preoperative," "routine," "screening," and "testing." The search was supplemented by accessing the "related articles" feature of PubMed with articles identified on MEDLINE and PubMed as the references. Pertinent studies published in English were reviewed. Studies or reports that described fewer than 10 patients were excluded from analysis if multiple series with greater than 10 patients addressing the same issue were available.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

See "Rating Scheme for the Strength of the Recommendations"

Systematic Review

Not stated

Expert Consensus

Guidelines for the appropriate practice of endoscopy are based on critical review of the available data and expert consensus.

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.

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review
Internal Peer Review

This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy. This document was reviewed and endorsed by the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Guidelines Committee and Board of Governors.

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").

Appropriate routine laboratory testing before endoscopic procedures

Not stated

Although pregnancy is not a contraindication to endoscopic procedures and the use of moderate sedation, there are situations when it is important to be aware of pregnancy status because it may affect certain procedural aspects such as use of fluoroscopy and choice of sedation agents.

• Further controlled clinical studies may be needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance with these recommendations.
• This guideline is designed to assist in the selection of patients for whom testing is performed, but it is not intended to determine how a health care professional applies these results to individual patients.

An implementation strategy was not provided.

Getting Better
Staying Healthy

Effectiveness

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.