PHOTOGRAPHIC DOCUMENTATION OF UPPER GASTROINTESTINAL LANDMARKS AT GASTROSCOPY: HOW GOOD IS IT?

Aims The European Society of Gastrointestinal Endoscopy (ESGE) guidelines describe a systematic approach to photo-documentation with a recommendation of eight anatomical landmarks to improve diagnostic endoscopy quality. This practice encourages mucosal cleansing, mucosal inspection and ensures a complete examination. The aim of this study was to retrospectively assess the photo-documentation at gastroscopy in clinical practice and compare this to the recommended sites as per the ESGE guidelines.

Methods Single centre retrospective analysis of 250 consecutive gastroscopies in a district general hospital endoscopy unit in London over a two week period in April 2019. Gastroscopy reports were scrutinized for photographic evidence of anatomical landmarks. The images captured on Unisoft GI Reporting Tool were analysed and compared to recommended ESGE guidelines. Patient comfort scores during the procedures (0 = no discomfort, 1 = one or two episodes, 2 = more than 2 episodes, 3 = significant discomfort) were also examined in relation to number of photographs obtained.

Results Of 250 gastroscopies performed, the eight anatomical landmarks were photographed during only 33 procedures (13%). In these 33 procedures the patient comfort scores were >1 (more than two episodes of discomfort) in 3 patients (9%) compared with 60 (28%) in the 217 patients with suboptimal photo-documentation (p = 0.02). In the 33 procedures where all the landmarks were photographed; 22 patients (66%) had conscious sedation, 11 (33%) patients had xylocaine throat spray.

Conclusions Photographic evidence of anatomical landmarks as per ESGE guidelines is only documented in 13%. Patient comfort and procedures under conscious sedation increase compliance with optimal photo-documentation. Photographic documentation improves the diagnostic quality of endoscopy and acts as a medico-legal record of an adequate procedure. There is much room for improvement in the photographic documentation of anatomical landmarks during gastroscopy.