Quality markers and patient experience should be implemented to ensure standardization of practice across upper gastrointestinal (UGI) endoscopy procedures. The set benchmarks ensure high quality procedures are delivered and linked to measurable outcomes. In 2016, the European Society of Gastrointestinal Endoscopy (ESGE), via its Quality Improvement Committee’s UGI Working Group, set a first list of performance measures, including major (key) and minor performance indicators. This paper provides an update on those performance measures, considering the latest literature. Patients referred for a UGI endoscopy should have an appropriate indication and be fasting for ≥ 2 hours for liquids and ≥ 6 hours for solids. For a diagnostic UGI endoscopy, patients should have an allocated time slot of ≥ 20 minutes; adequate reporting should include a mucosal visibility score according to one of the available standardized and validated scales; adequate photodocumentation should include relevant normal anatomical landmarks and all abnormal findings; adequate inspection should include the esophagus, stomach, and duodenum, and should last ≥ 7 minutes from intubation to extubation; adequate terminology should include the description of any abnormal finding according to the available standardized and validated classifications. For patients with nondysplastic Barrett’s esophagus (BE) undergoing surveillance UGI endoscopy, an adequate inspection should take ≥ 1 minute/cm of circumferential extent of Barrett’s epithelium and include the use of chromoendoscopy (acetic acid and/or virtual); biopsies should be taken according to the Seattle protocol. Adequate inspection for a diagnostic UGI endoscopy in patients with a history of ear, nose, and throat, or lung tumors treated with curative intent should include the use of virtual chromoendoscopy. Adequate diagnostic UGI endoscopy for patients evaluated for their risk of gastric cancer should include biopsies taken according to the ESGE management of precancerous conditions and lesions in the stomach (MAPS) guideline. Adequate safety after a therapeutic UGI endoscopy should be assessed by monitoring the incidence of complications. Patients undergoing a diagnostic UGI endoscopy should have their experience measured using a validated scale, to promote a patient-centered and quality-driven environment. Patients with nondysplastic BE or gastric precancerous conditions in an endoscopic surveillance program should be monitored for guideline interval adherence.

Survival and outcomes for co-infection of chronic hepatitis C with and without cirrhosis and COVID-19: A multicenter retrospective study

For many years, we have faced the complications of viral hepatitis and alcohol-related liver diseases such as cirrhosis, decompensation, portal hypertension, and hepatocellular carcinoma (HCC). Recently, we have seen a dynamic change in the field of hepatology. With the significant achievements in eradicating the hepatitis C virus by direct-acting antiviral agents and the rising epidemic of obesity, diabetes mellitus, and metabolic syndrome, there is a paradigm shift in the leading cause of liver cirrhosis and cancer to nonalcoholic fatty liver disease (NAFLD). Current data highlight the rapidly rising incidence of NAFLD-related HCC worldwide and expose the unseen part of the iceberg. In this review, we aim to update knowledge about the pathogenesis of NAFLD-induced HCC, surveillance difficulties, and promising disease markers. Molecular biomarkers, for example, may become a promising cornerstone for risk-stratified surveillance, early detection, and treatment selection for NAFLD-related HCC. Physicians can offer personalized and tailor-made clinical decisions for this unique patient subgroup.

Upper gastrointestinal (UGI) endoscopy is the mainstay for the diagnosis and staging of precancerous and cancerous conditions of the esophagus, stomach, and duodenum. Despite development of several validated classifications for UGI diseases, endoscopy reports differ between endoscopists and endoscopy departments. This document proposes a standardized high quality UGI endoscopy report, including preprocedural, periprocedural, endoscopic findings, and postprocedural information. Preprocedural details should comprise data on the patient, exam, use of antithrombotic drugs, fasting, and premedication. Periprocedural information should report on medications administered, endoscope used, and the mucosal cleanliness assessment. Endoscopic findings should describe the esophagus, stomach, and duodenum, with any observed abnormalities reported using the most commonly employed classification (provided in the document). Postprocedural details should include data on biopsies and vials, pictures taken during the procedure, and the exam duration. A suggestion for a normal findings report is provided. Standardized reporting could enhance the quality of UGI endoscopy.

Statements: 1 The European Society of Gastrointestinal Endoscopy (ESGE) adheres to the overarching principles of equality of opportunity, fair treatment, nondiscrimination, and diversity of health care professionals. 2 ESGE strongly supports the creation of collaborations within and between national and international endoscopy societies to disseminate the principles of diversity, equality, and inclusion (DEI) in the field of gastrointestinal (GI) endoscopy. 3 ESGE aims to reflect the diversity of its membership in all its scientific and educational activities. 4 ESGE supports the fostering of collaborative work settings that empower all members of the endoscopy team to reach their full potential. 5 ESGE supports international and national endoscopy societies in promoting equitable access to high quality endoscopy training. 6 ESGE recommends the implementation of ergonomic principles in endoscopy units to prevent injuries and to provide adapted workplace conditions for personnel with disabilities and/or special needs. 7 ESGE recommends comprehensive mentorship, that includes diverse backgrounds, and equitable sponsorship for professional development, training, and academic excellence. 8 ESGE recommends that endoscopists actively identify, discuss, and attempt to accommodate reasonable patient preferences and expectations regarding endoscopy procedures. 9 ESGE advocates for educational and awareness campaigns targeting both health care professionals and patients, as well as the adoption of cost-effective health care strategies to address disparities and enhance equity in endoscopy care. 10 ESGE is committed to increasing support for underrepresented scholars and minorities pursuing research in endoscopy. 11 ESGE identifies mentorship and sponsorship as factors that may mitigate the barriers to academic careers for underrepresented endoscopy scholars. 12 ESGE recognizes the need to increase awareness of diversity, equity, and inclusion (DEI) in the field of endoscopy and supports publications on these topics.

Background: Hepatitis C virus (HCV)-related decompensated cirrhosis is a severe life-threatening illness. The safety of direct-acting antivirals (DAAs) has opened a gate of hope for that subgroup of patients who were previously contraindicated for interferon therapy. Objective: We aimed at the investigation of the safety and efficacy of different DAAs regimens in the treatment of HCV-related decompensated cirrhosis patients, to determine sustained virological response (SVR)12 rates and to analyze the factors associated with response. Methods: A retrospective, single-center study including HCV-related decompensated cirrhosis patients who received DAAs. Demographic, laboratory and clinical data were analyzed. The SVR12 rate was the primary outcome measure. Secondary outcomes included the predictors of response, changes in the baseline model for end-stage liver disease and child-turcotte-pugh (CTP) scores, and fibroindices (APRI and fibrosis-4 index) at 12 weeks after treatment. Results: In total, 145 eligible patients (141 with CTP class B and 4 with class C) were enrolled in this study. SVR12 was achieved by 88.06% (118/134) of efficacy population on different DAAs regimens, Treatment was discontinued in 11 patients because of severe side effects without any deaths. Younger age showed a significant positive association with SVR12. Conclusions: DAAs can be used for the treatment of HCV-related decompensated liver disease, with acceptable SVR12 rates and safety profiles.