Issue​ 04 - Maximising the Quality of Diagnostic Endoscopy

Introduction
Maximising the Quality of Diagnostic Endoscopy

This introductory video welcomes you to issue 4 of the Video Journal of the ESGE Academy. Quality in diagnostic endoscopy is critical. The vast majority of endoscopic procedures are diagnostic, yet we know from multiple sources—particularly established data on post-colonoscopy colorectal cancer and emerging data on post-gastroscopy upper GI cancer—that the quality of these examinations varies considerably.

Biopsy in Upper GI Endoscopy
Targeted biopsies and systematic mapping

This video provides a structured practical guide to performing biopsies during upper GI endoscopy, focusing on correct anatomical orientation and standardised sampling protocols. It outlines the Seattle protocol for Barrett’s oesophagus surveillance and reviews MAPS III recommendations for gastric mapping, including the optimal number and location of biopsies in the antrum and corpus. The video also demonstrates biopsy techniques to maximise tissue capture, illustrates the use of acetic acid and advanced imaging for dysplasia detection, and highlights how to avoid common pitfalls such as sampling the prepyloric region.

Quality in Colonoscopy
Optimising withdrawal technique to improve detection and outcomes

This presentation focuses on quality in colonoscopy with a specific emphasis on scope withdrawal. It reviews key performance indicators for high-quality lower gastrointestinal endoscopy and explains the rationale behind meticulous withdrawal technique. Practical strategies are discussed across three domains—equipment, endoscopic technique, and patient-related factors—to optimise mucosal visualisation and lesion detection. 

Case-based video examples and procedural tips are used to demonstrate evidence-based approaches such as thorough caecal inspection, fold examination, retroflexion, and position changes, with reference to current guidelines and supporting literature.

Maximising quality of "diagnostic" ERCP
Getting the diagnosis right before ERCP and the technique right during it

This video explores how to maximise quality in diagnostic ERCP by focusing on the limited situations where the procedure is truly needed. We outline why diagnostic ERCP is now mainly reserved for tissue sampling in indeterminate biliary strictures, and how imaging should guide decision making in most other cases. Through real examples, we highlight the importance of careful case selection, high-quality fluoroscopic imaging and effective tissue acquisition so that when ERCP is performed, it delivers the intended therapy safely and with confidence.

Quality in diagnostic (HPB) EUS
Optimizing images interpretation and sampling

High-quality diagnostic endoscopic ultrasound (EUS) is essential for accurate evaluation of hepatopancreatobiliary (HPB) system. This video focuses on key principles, tips and tricks for optimizing image acquisition, and tissue sampling to improve diagnostic yield and clinical decision-making. Emphasis is placed on systematic examination techniques, recognition of anatomical landmarks and structured reporting. In addition, best practices and technical advice for EUS-guided tissue acquisition are presented, covering needle selection, sampling techniques, and specimen handling to maximize adequacy and accuracy. These quality-focused approaches aim to improve the reliability, reproducibility, and clinical impact of diagnostic HPB EUS.