Grading the complexity of endoscopic procedures: results of an ASGE working party

Published:March 07, 2011DOI:


      Working parties of the American Society for Gastrointestinal Endoscopy (ASGE) Quality Committee recently published a proposed new lexicon for adverse events and a separate extensive review of risk factors. The complexity of procedures also affects outcomes.


      To establish a system for grading the complexity of endoscopic procedures.


      Voting on levels 1 (easiest) to 4 (most difficult) on a list of possible procedures and contexts.


      Community and academic gastroenterologists in the United States, Canada, and Britain.

      Main Outcome Measurements

      Median scores of votes cast.


      Consensus list of levels 1 through 4 contexts and procedures.


      Eminence rather than evidence based.


      A consensus list was developed for comments and testing to complement the proposed lexicons for adverse events and risk factors.


      ASGE (American Society for Gastrointestinal Endoscopy)
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        • Cotton P.B.
        • Eisen G.M.
        • Aabakken L.
        • et al.
        A lexicon for endoscopic adverse events: report of an ASGE workshop.
        Gastrointest Endosc. 2010; 71: 446-454
        • Schutz S.M.
        • Abbott R.M.
        Grading ERCPs by degree of difficulty: a new concept to produce more meaningful outcome data.
        Gastrointest Endosc. 2000; 51: 535-539
        • Cotton P.B.
        Income and outcome metrics for the objective evaluation of ERCP and alternative methods.
        Gastrointest Endosc. 2002; 56: S283-S290
        • Madhotra R.
        • Cotton P.B.
        • Vaughn J.
        • et al.
        Analyzing ERCP practice by a modified degree of difficulty scale: a multicenter database analysis.
        Am J Gastroenterol. 2000; 95: 2480-2481
        • Raganath K.
        • Thomas L.A.
        • Cheung W.Y.
        • et al.
        Objective evaluation of ERCP procedures: a simple grading scale for evaluating technical difficulty.
        Postgrad Med J. 2003; 79: 467-470
      1. Romagnuolo J, Cotton PB, Eisen G, et al. Identifying and reporting risk factors for adverse events in endoscopy. Part I: cardiopulmonary events. Gastrointest Endosc (in press).

      2. Romagnuolo J, Cotton PB, Eisen G, et al. Identifying and reporting risk factors for adverse events in endoscopy. Part II: noncardiopulmonary events. Gastrointest Endosc (in press).

        • Cotton P.B.
        How many times have you done this procedure, doctor?.
        Am J Gastroenterol. 2002; 97: 522-523
      3. Available at: Accessed December, 2010.