Endoscopy Services

Comprised of ten chapters, ASGE’s Policy and Procedure Reference Guide for Ambulatory Surgical Centers (ASCs) is intended to provide an organized list of ASGE guidelines that may be considered appropriate for adoption in an endoscopy facility.

Presented in chart form, the Reference Guide highlights ASGE guidelines that meet standards and conditions in the Centers for Medicare and Medicaid Services (CMS) Condition for Coverage.

Note that the basic CMS Standards and how they are to be interpreted by surveyors from any Accrediting Organization can be found in the CMS State Operations Manual. Appendix A (Conditions of Participation) covers hospitals while Appendix L (Conditions for Coverage) covers Ambulatory Surgery Centers.1

For a quick summary of recommendations when reviewing any of the ASGE Guidelines we recommend going to the “Recommendations” section located at the bottom of each ASGE Guideline.

To read the overview or additional chapters, please click here.

Introduction

Standards developed for endoscopic services are generally found in the Surgical Services section. It is in this section that endoscopy facilities need to pay careful attention to policies from non-gastroenterology national organizations before adopting them. The standards require that the surgical procedures must be performed in a “safe manner.” Many policies developed for safe and sterile surgical environments are not appropriate for non-sterile endoscopy rooms. However, once an organization adopts policies, they are held to the standard of those specific policies during accreditation surveys. In other words, if an endoscopic facility adopts policies for a sterile surgical environment, The Centers for Medicare and Medicaid Services (CMS) expects those policies be followed. “In a safe manner” means that procedures follow acceptable surgical standards of practice in all phases of a surgical procedure, beginning with the pre-operative preparation of the patient, through to the post-operative recovery and discharge.

Acceptable standards of practice include maintaining compliance with applicable Federal and State laws, regulations and guidelines governing surgical services, as well as, any standards and recommendations promoted by or established by nationally recognized professional organizations.

CMS recognizes ASGE guidelines as acceptable standards of practice for endoscopic procedures.

For more in-depth information regarding interpretative guidelines and surveyor procedures, access the CMS State Operations Manual, Guidance for Surveyors: Ambulatory Surgical Centers (Appendix L).1

CMS Conditions for Coverage and Standards Related to Endoscopy Services

§416.42 Condition for Coverage: Surgical Services

Surgical procedures must be performed in a safe manner by qualified physicians who have been granted clinical privileges by the governing body of the ASC in accordance with approved policies and procedures of the ASC.

 

ASGE Guidelines and Recommendations Related to §416.42

 

Issue

ASGE Guideline

ASGE Applicable Recommendations

Pre-Procedure Aspects of Care

Testing prior to endoscopic procedures including recommendations against non-selective routine testing, pregnancy testing and coagulation.

Routine laboratory testing before endoscopic procedures. 

GASTROINTEST ENDOSC 2014; 80(1): 28-312
  • 1-8

Management of anticoagulants for a variety of situations common to endoscopy based on the bleeding risk of the procedure and the medical conditions.

The management of antithrombotic agents for patients undergoing GI endoscopy.

GASTROINTEST ENDOSC 2016; 83(1): 3-143
  • Section A (Elective endoscopic procedures)
  • Section B (Urgent and emergent endoscopic procedures)

Bowel preparation before colonoscopy.

Bowel preparation before colonoscopy.

GASTROINTEST ENDOSC 2015; 81(4): 781-904
  • 1-9

 

Patient Populations

Management of pregnant patients requiring endoscopy, recommendations regarding breast feeding women requiring endoscopy.

 

Guidelines for endoscopy in pregnant and lactating women.

GASTROINTEST ENDOSC 2012; 76(1): 18-235
  • 1-8 (Pregnancy)
  • 1-5 (Lactation)

Endoscopy in the pediatric population.

Modifications in endoscopic practice for pediatric patients.

GASTROINTEST ENDOSC 2014; 79(5): 699-7076
  • 1-9

Managing geriatric patients requiring endoscopy.

Modifications in endoscopic practice for the elderly.

GASTROINTEST ENDOSC 2013; 78(1): 1-77
  • 1-8

Policies for industry representatives in the endoscopy unit.

The Role of Industry Representatives in the Endoscopy Unit.

AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY, 20158
  • 1-13

Informed consent for GI endoscopy.

Informed consent for GI endoscopy.

GASTROINTEST ENDOSC 2007; 66(2): 213-179
  • 1-5

Infection control for GI Endoscopy.

Guidelines for safety in the gastrointestinal endoscopy unit.

GASTROINTEST ENDOSC 2014; 79(3): 363-7010
  • 1-4 (PPE Low-risk/High-risk)
  • 1 (Staffing)

Minimum safe staffing levels.

Minimum staffing requirements for the performance of GI endoscopy.

GASTROINTEST ENDOSC 2020; 91(4): 723-2811
  • Table 1

ASGE guidelines that address the appropriate use of endoscopy for specific procedures and conditions.

 

 

ASGE Guidelines for specific procedures and conditions are categorized as follows:

Miscellaneous

GASTROINTEST ENDOSC 2013;78(2): 216-2412

GASTROINTEST ENDOSC 2012;75(6):1127-3113
  • All recommendations

  
Tips for Recommendations from ASGE Guidelines

1. A statement should be made citing the ASGE references as recommendations from a nationally recognized specialty society that were used in the development of this reference.

2. If other nationally recognized society guidelines are also being used to develop policies and procedures, it is important to review those policies and reconcile differences so that contradictory policies are not developed.

3. The Association of Operating Room Nurses (AORN) has specific policies requiring surgical attire, staffing, and restricted areas that endoscopy facilities may not wish to adopt. In the interpretive guidelines, AORN’s standards are mentioned as an example of nationally recognized standards. CMS surveyors, therefore, may hold facilities to those standards unless they have specifically adopted others.

4.  Documentation of the adoption of ASGE guidelines should be referenced in the meeting minutes of the organization’s governing body. The reference should include the guideline, the portion of the guideline to be adopted, and an education plan for staff and providers as needed.

Endnotes

  1. CMS State Operations Manual, Guidance for Surveyors: Ambulatory Surgical Centers (Appendix L). Centers for Medicare and Medicaid Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_l_ambulatory.pdf.
  2. Routine Laboratory Testing Before Endoscopic Procedures. GASTROINTEST ENDOSC 2014; 80(1): 28-31.
  3. The Management of Antithrombotic Agents for Patients Undergoing GI Endoscopy. GASTROINTEST ENDOSC 2016; 83(1): 3-14.
  4. Bowel Preparation Before Colonoscopy. GASTROINTEST ENDOSC 2015; 81(4): 781-90.
  5. Guidelines for Endoscopy in Pregnant and Lactating Women. GASTROINTEST ENDOSC 2012; 76(1): 18-23.
  6. Modifications In Endoscopic Practice for Pediatric Patients. GASTROINTEST ENDOSC 2014; 79(5): 699-707.
  7. Modifications In Endoscopic Practice for the Elderly. GASTROINTEST ENDOSC 2013; 78(1): 1-7.
  8. The Role of Industry Representatives in the Endoscopy Unit. American Society for Gastrointestinal Endoscopy, 2015.
  9. Informed Consent for GI Endoscopy. GASTROINTEST ENDOSC 2007; 66(2): 213-17.
  10. Guidelines for Safety in the Gastrointestinal Endoscopy Unit. GASTROINTEST ENDOSC 2014; 79(3): 363-70.
  11. Minimum Staffing Requirements for the Performance of GI Endoscopy. GASTROINTEST ENDOSC 2020; 91(4): 723-28.
  12. Endoscopic Mucosal Tissue Sampling. GASTROINTEST ENDOSC 2013; 78(2): 216-24.
  13. Appropriate Use of GI Endoscopy GASTROINTEST ENDOSC 2012;75(6):1127-31.