Subscribe to RSS
DOI: 10.1055/a-2716-7763
Performance measures for endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative – Update 2025
Authors
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) recommends that endoscopy services across Europe adopt the following six key performance measures for endoscopic ultrasound (EUS) for monitoring and evaluation in daily practice at center and endoscopist level: (1) informed patient consent (100 % of procedures); (2) adequate documentation of landmarks (≥ 90 % of procedures); (3) structured training and supervision for trainees, preferably using assessment tools (≥ 20 %); (4) standardized description of pancreatic cystic lesions (≥ 85 %); (5) diagnostic tissue acquisition with EUS-guided fine-needle aspiration/fine-needle biopsy for solid lesions (≥ 85 %); (6) adverse events (< 5 % in cystic and < 3 % in solid lesions). A recommendation to administer antibiotics for EUS-guided puncture of cystic lesions, included in the previous ESGE quality improvement document, has been omitted in the current version based on recent evidence.
Publication History
Article published online:
12 November 2025
© 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References
- 1 Rutter MD, Senore C, Bisschops R. et al. The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures. Endoscopy 2016; 48: 81-89
- 2 Bisschops R, Areia M, Coron E. et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2016; 48: 843-864
- 3 Dekker E, Nass KJ, Iacucci M. et al. Performance measures for colonoscopy in inflammatory bowel disease patients: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2022; 54: 904-915
- 4 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
- 5 Spada C, McNamara D, Despott EJ. et al. Performance measures for small-bowel endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2019; 51: 574-598
- 6 Valori R, Cortas G, de Lange T. et al. Performance measures for endoscopy services: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2018; 50: 1186-1204
- 7 Domagk D, Oppong KW, Aabakken L. et al. Performance measures for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United European Gastroenterol J 2018; 6: 1448-1460
- 8 Guyatt GH, Oxman AD, Kunz R. et al. Going from evidence to recommendations. BMJ 2008; 336: 1049-1051
- 9 Linstone HA, Turoff M. The Delphi Method: Techniques and Applications. Reading, MA, USA: Addison Wesley Publishing; 2002
- 10 Bretthauer N, Aabakken L, Dekker E. et al. Requirements and standards facilitating quality improvement for reporting systems in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2016; 48: 291-294
- 11 Everett SM, Triantafyllou K, Hassan C. et al. Informed consent for endoscopic procedures: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2023; 55: 952-966
- 12 Dumonceau JM, Deprez PH, Jenssen C. et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017. Endoscopy 2017; 49: 695-714
- 13 van der Merwe SW, van Wanrooij RLJ, Bronswijk M. et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54: 185-205
- 14 DiMagno EP, DiMagno MJ. Chronic pancreatitis: landmark papers, management decisions, and future. Pancreas 2016; 45: 641-650
- 15 Irisawa A, Yamao K. Curved linear array EUS technique in the pancreas and biliary tree: focusing on the stations. Gastrointest Endosc 2009; 69: S84-S89
- 16 Khalid S, Hegde P. Interventional pulmonology and esophagus: combined endobronchial ultrasound and endoscopic ultrasound for mediastinal staging. Semin Respir Crit Care Med 2022; 43: 583-592
- 17 Okasha HH, Farouk M, El Hendawy RI. et al. Practical approach to linear EUS examination of the liver. Endosc Ultrasound 2021; 10: 161-167
- 18 Sharma M, Pathak A, Shoukat A. et al. Imaging of spaces of neck and mediastinum by endoscopic ultrasound. Lung India 2016; 33: 292-305
- 19 Zhou S, Buxbaum J. Advanced imaging of the biliary system and pancreas. Dig Dis Sci 2022; 67: 1599-1612
- 20 Johnson G, Webster G, Boskoski I. et al. Curriculum for ERCP and endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2021; 53: 1071-1087
- 21 Wani S, Wallace MB, Cohen J. et al. Quality indicators for EUS. Gastrointest Endosc 2015; 81: 67-80
- 22 Karstensen JG, Nayahangan LJ, Konge L. et al. A core curriculum for basic EUS skills: An international consensus using the Delphi methodology. Endosc Ultrasound 2022; 11: 122-132
- 23 Ekkelenkamp VE, Koch AD, de Man RA. et al. Training and competence assessment in GI endoscopy: a systematic review. Gut 2016; 65: 607-615
- 24 Lim BS, Leung JW, Lee J. et al. Effect of ERCP mechanical simulator (EMS) practice on trainees' ERCP performance in the early learning period: US multicenter randomized controlled trial. Am J Gastroenterol 2011; 106: 300-306
- 25 Siau K, Dunckley P, Valori R. et al. Changes in scoring of Direct Observation of Procedural Skills (DOPS) forms and the impact on competence assessment. Endoscopy 2018; 50: 770-778
- 26 Ward ST, Hancox A, Mohammed MA. et al. The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database. Gut 2017; 66: 1022-1033
- 27 Wani S, Hall M, Keswani RN. et al. Variation in aptitude of trainees in endoscopic ultrasonography, based on cumulative sum analysis. Clin Gastroenterol Hepatol 2015; 13: 1318-1325 e1312
- 28 Wani S, Hall M, Wang AY. et al. Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis. Gastrointest Endosc 2016; 83: 711-719 e711
- 29 Wani S, Keswani RN, Petersen B. et al. Training in EUS and ERCP: standardizing methods to assess competence. Gastrointest Endosc 2018; 87: 1371-1382
- 30 Liu K, Elmunzer BJ, Wani S. et al. The Bethesda ERCP Skills Assessment Tool (BESAT) can reliably differentiate endoscopists of different experience levels. Endosc Int Open 2024; 12: E324-E331
- 31 Wani S, Keswani R, Hall M. et al. A prospective multicenter study evaluating learning curves and competence in endoscopic ultrasound and endoscopic retrograde cholangiopancreatography among advanced endoscopy trainees: the rapid assessment of trainee endoscopy skills study. Clin Gastroenterol Hepatol 2017; 15: 1758-1767 e1711
- 32 Siau K, Dunckley P, Feeney M. et al. ERCP assessment tool: evidence of validity and competency development during training. Endoscopy 2019; 51: 1017-1026
- 33 de Campos ST, Arvanitakis M, Deviere J. A portrait of Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound training programs in Europe: Current practices and opportunities for improvement. United European Gastroenterol J 2023; 11: 350-360
- 34 Dahiya DS, Shah YR, Ali H. et al. Basic principles and role of endoscopic ultrasound in diagnosis and differentiation of pancreatic cancer from other pancreatic lesions: a comprehensive review of endoscopic ultrasound for pancreatic cancer. J Clin Med 2024; 13: 2599
- 35 Morana G, Ciet P, Venturini S. Cystic pancreatic lesions: MR imaging findings and management. Insights Imaging 2021; 12: 115
- 36 Ohtsuka T, Fernandez-Del Castillo C, Furukawa T. et al. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology 2024; 24: 255-270
- 37 Tanaka M, Fernandez-Del Castillo C, Kamisawa T. et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017; 17: 738-753
- 38 Choi SY, Kim JH, Yu MH. et al. Diagnostic performance and imaging features for predicting the malignant potential of intraductal papillary mucinous neoplasm of the pancreas: a comparison of EUS, contrast-enhanced CT and MRI. Abdom Radiol (NY) 2017; 42: 1449-1458
- 39 Fujita M, Itoi T, Ikeuchi N. et al. Effectiveness of contrast-enhanced endoscopic ultrasound for detecting mural nodules in intraductal papillary mucinous neoplasm of the pancreas and for making therapeutic decisions. Endosc Ultrasound 2016; 5: 377-383
- 40 Fusaroli P, Serrani M, De Giorgio R. et al. Contrast harmonic-endoscopic ultrasound is useful to identify neoplastic features of pancreatic cysts (with videos). Pancreas 2016; 45: 265-268
- 41 Hisa T, Kudo A, Shimizu T. et al. Ultrasonographic features of nonneoplastic protrusions in pancreatic cysts by contrast-enhanced endoscopic ultrasound. Pancreas 2023; 52: e328-e334
- 42 Singh RR, Gopakumar H, Sharma NR. Diagnosis and management of pancreatic cysts: a comprehensive review of the literature. Diagnostics (Basel) 2023; 13: 550
- 43 Costache MI, Iordache S, Karstensen JG. et al. Endoscopic ultrasound-guided fine needle aspiration: from the past to the future. Endosc Ultrasound 2013; 2: 77-85
- 44 Facciorusso A, Ramai D, Gkolfakis P. et al. Through-the-needle biopsy of pancreatic cystic lesions: current evidence and implications for clinical practice. Expert Rev Med Devices 2021; 18: 1165-1174
- 45 Kovacevic B, Antonelli G, Klausen P. et al. EUS-guided biopsy versus confocal laser endomicroscopy in patients with pancreatic cystic lesions: A systematic review and meta-analysis. Endosc Ultrasound 2021; 10: 270-279
- 46 Machicado JD, Napoleon B, Akshintala V. et al. Structured training program on confocal laser endomicroscopy for pancreatic cystic lesions: a multicenter prospective study among early-career endosonographers (with video). Gastrointest Endosc 2023; 98: 953-964
- 47 Rift CV, Melchior LC, Kovacevic B. et al. Targeted next-generation sequencing of EUS-guided through-the-needle-biopsy sampling from pancreatic cystic lesions. Gastrointest Endosc 2023; 97: 50-58 e54
- 48 Gkolfakis P, Crino SF, Tziatzios G. et al. Comparative diagnostic performance of end-cutting fine-needle biopsy needles for EUS tissue sampling of solid pancreatic masses: a network meta-analysis. Gastrointest Endosc 2022; 95: 1067-1077 e1015
- 49 Kovacevic B, Toxvaerd A, Klausen P. et al. Tissue amount and diagnostic yield of a novel franseen EUS-FNB and a standard EUS-FNA needle-A randomized controlled study in solid pancreatic lesions. Endosc Ultrasound 2023; 12: 319-325
- 50 Mangiavillano B, Facciorusso A, Di Matteo FM. et al. Establishing the optimal number of passes during EUS-FNB for diagnosis of pancreatic solid lesions: Prospective multicenter study. Endosc Int Open 2024; 12: E467-E473
- 51 Verloop CA, Goos JAC, Bruno MJ. et al. Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review. Gastrointest Endosc 2024; 99: 895-911 e813
- 52 Badaoui A, Teles de Campos S, Fusaroli P. et al. Curriculum for diagnostic endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2024; 56: 222-240
- 53 Pouw RE, Barret M, Biermann K. et al. Endoscopic tissue sampling - Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 1174-1188
- 54 Facciorusso A, Crino SF, Fugazza A. et al. Comparative diagnostic yield of different endoscopic techniques for tissue sampling of upper gastrointestinal subepithelial lesions: a network meta-analysis. Endoscopy 2024; 56: 31-40
- 55 Crino SF, Le Grazie M, Manfrin E. et al. Randomized trial comparing fork-tip and side-fenestrated needles for EUS-guided fine-needle biopsy of solid pancreatic lesions. Gastrointest Endosc 2020; 92: 648-658 e642
- 56 Polkowski M, Jenssen C, Kaye P. et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. Endoscopy 2017; 49: 989-1006
- 57 Facciorusso A, Crino SF, Ramai D. et al. Comparative diagnostic performance of different techniques for EUS-guided fine-needle biopsy sampling of solid pancreatic masses: a network meta-analysis. Gastrointest Endosc 2023; 97: 839-848 e835
- 58 Chalhoub JM, Hawa F, Grantham T. et al. Effect of the number of passes on diagnostic performance of EUS-fine needle biopsy of solid pancreatic masses: A systematic review and meta-analysis. Gastrointest Endosc 2024; 100: 595-604.e8
- 59 Mangiavillano B, Crino SF, Facciorusso A. et al. Endoscopic ultrasound-guided fine-needle biopsy with or without macroscopic on-site evaluation: a randomized controlled noninferiority trial. Endoscopy 2023; 55: 129-137
- 60 Mohan BP, Madhu D, Reddy N. et al. Diagnostic accuracy of EUS-guided fine-needle biopsy sampling by macroscopic on-site evaluation: a systematic review and meta-analysis. Gastrointest Endosc 2022; 96: 909-917 e911
- 61 Facciorusso A, Arvanitakis M, Crino SF. et al. Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review. Endoscopy 2025; 57: 390-418
- 62 Levy MJ, Abu Dayyeh BK, Fujii LL. et al. Prospective evaluation of adverse events following lower gastrointestinal tract EUS FNA. Am J Gastroenterol 2014; 109: 676-685
- 63 Rodriguez-D'Jesus A, Fernandez-Esparrach G, Marra-Lopez C. et al. Adverse events of EUS-guided FNA of pancreatic cystic and solid lesions by using the lexicon proposed in an ASGE workshop: a prospective and comparative study. Gastrointest Endosc 2016; 83: 780-784
- 64 Tan Y, Tang X, Huang J. et al. Efficacy, feasibility, and safety of endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of gastrointestinal subepithelial lesions: a systematic review and meta-analysis. J Clin Gastroenterol 2022; 56: e283-e292
- 65 Zhu H, Jiang F, Zhu J. et al. Assessment of morbidity and mortality associated with endoscopic ultrasound-guided fine-needle aspiration for pancreatic cystic lesions: A systematic review and meta-analysis. Dig Endosc 2017; 29: 667-675
- 66 Tian G, Ye Z, Zhao Q. et al. Complication incidence of EUS-guided pancreas biopsy: A systematic review and meta-analysis of 11 thousand population from 78 cohort studies. Asian J Surg 2020; 43: 1049-1055
- 67 Li Z, Liu W, Xu X. et al. A meta-analysis comparing endoscopic ultrasound-guided fine-needle aspiration with endoscopic ultrasound-guided fine-needle biopsy. J Clin Gastroenterol 2022; 56: 668-678
- 68 Cho E, Park CH, Kim TH. et al. A prospective, randomized, multicenter clinical trial comparing 25-gauge and 20-gauge biopsy needles for endoscopic ultrasound-guided sampling of solid pancreatic lesions. Surg Endosc 2020; 34: 1310-1317
- 69 Laquiere A, Lefort C, Maire F. et al. 19 G nitinol needle versus 22 G needle for transduodenal endoscopic ultrasound-guided sampling of pancreatic solid masses: a randomized study. Endoscopy 2019; 51: 436-443
- 70 Veitch AM, Radaelli F, Alikhan R. et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut 2021; 70: 1611-1628
- 71 Giri S, Afzalpurkar S, Anirvan P. et al. Risk of bleeding with endoscopic ultrasound-guided tissue acquisition in patients on antithrombotic therapy: a systematic review and meta-analysis. Dig Dis Sci 2023; 68: 1950-1958
- 72 Inoue T, Okumura F, Sano H. et al. Bleeding risk of endoscopic ultrasound-guided fine-needle aspiration in patients undergoing antithrombotic therapy. Dig Endosc 2017; 29: 91-96
- 73 Nagata N, Yasunaga H, Matsui H. et al. Therapeutic endoscopy-related GI bleeding and thromboembolic events in patients using warfarin or direct oral anticoagulants: results from a large nationwide database analysis. Gut 2018; 67: 1805-1812
- 74 Colan-Hernandez J, Sendino O, Loras C. et al. Antibiotic prophylaxis is not required for endoscopic ultrasonography-guided fine-needle aspiration of pancreatic cystic lesions, based on a randomized trial. Gastroenterology 2020; 158: 1642-1649 e1641
- 75 Gopakumar H, Puli SR. Value of endoscopic ultrasound-guided through-the-needle biopsy in pancreatic cystic lesions. a systematic review and meta-analysis. J Gastrointest Cancer 2024; 55: 15-25
- 76 Khoury T, Gincul R, Mohammedi I. et al. Antibioprophylaxis in endoscopic ultrasound guided fine needle aspiration in pancreatic cysts: A systematic review and meta-analysis. J Gastroenterol Hepatol 2022; 37: 1685-1692
- 77 Wang X, Hu J, Yang F. et al. Needle-based confocal laser endomicroscopy for diagnosis of pancreatic cystic lesions: a meta-analysis. Minim Invasive Ther Allied Technol 2022; 31: 653-663
- 78 Kitano M, Yoshida M, Ashida R. et al. Needle tract seeding after endoscopic ultrasound-guided tissue acquisition of pancreatic tumors: A nationwide survey in Japan. Dig Endosc 2022; 34: 1442-1455
- 79 Yane K, Kuwatani M, Yoshida M. et al. Non-negligible rate of needle tract seeding after endoscopic ultrasound-guided fine-needle aspiration for patients undergoing distal pancreatectomy for pancreatic cancer. Dig Endosc 2020; 32: 801-811
- 80 Ikezawa K, Uehara H, Sakai A. et al. Risk of peritoneal carcinomatosis by endoscopic ultrasound-guided fine needle aspiration for pancreatic cancer. J Gastroenterol 2013; 48: 966-972
- 81 Kim SH, Woo YS, Lee KH. et al. Preoperative EUS-guided FNA: effects on peritoneal recurrence and survival in patients with pancreatic cancer. Gastrointest Endosc 2018; 88: 926-934
- 82 Maruta A, Iwashita T, Yoshida K. et al. Evaluation of preoperative diagnostic methods for resectable pancreatic cancer: a diagnostic capability and impact on the prognosis of endoscopic ultrasound-guided fine needle aspiration. BMC Gastroenterol 2021; 21: 382
- 83 Ngamruengphong S, Xu C, Woodward TA. et al. Risk of gastric or peritoneal recurrence, and long-term outcomes, following pancreatic cancer resection with preoperative endosonographically guided fine needle aspiration. Endoscopy 2013; 45: 619-626
- 84 Teh JL, Tan JR, Lau LJ. et al. Longer examination time improves detection of gastric cancer during diagnostic upper gastrointestinal endoscopy. Clin Gastroenterol Hepatol 2015; 13: 480-487 e482
- 85 Yoshimizu S, Hirasawa T, Horiuchi Y. et al. Differences in upper gastrointestinal neoplasm detection rates based on inspection time and esophagogastroduodenoscopy training. Endosc Int Open 2018; 6: E1190-E1197
- 86 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. NEJM 2010; 362: 1795-1803
- 87 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. NEJM 2014; 370: 1298-1306
- 88 Khashab MA, Chithadi KV. ASGE Standards of Practice Committee. et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2015; 81: 81-89
- 89 Facciorusso A, Mohan BP, Tacelli M. et al. Use of antibiotic prophylaxis is not needed for endoscopic ultrasound-guided fine-needle aspiration of pancreatic cysts: a meta-analysis. Expert Rev Gastroenterol Hepatol 2020; 14: 999-1005
- 90 Palomera-Tejeda E, Shah H, Attar BM. et al. Prophylactic antibiotics do not prevent infectious complications of endoscopic ultrasound fine-needle aspiration of pancreatic cysts: a systematic review and meta-analysis. Pancreas 2021; 50: 667-672
