Establishing a quality indicator format for endoscopic ultrasound

Table 1 Endoscopic ultrasound quality indicators

Pre-EUS indicators

Indications for procedure

Detailed description of the patient by the referring physician

Patient completed procedural preparation of minimum 6 h NPO

Antibiotics per protocol were given in the need to perform FNA of pancreatic cysts

Listing of sedatives administered prior to and during EUS

Patient signed agreement of informed consent for EUS and/or if consented for research study

Intra-procedural indicators

A detailed description of the methods used to visualize routinely evaluated EUS organs. If there is any suspicion of organ pathology, the respective organ parenchyma should be described:

Suspected pancreatic lesions should include a parenchymal description including the body, head, tail, and duct

Common bile ducts and gallbladder contents should be detailed and a description of the biliary tree for sludge, stones, or other findings

If found, prominent lymph nodes should be described in detail as well as the kidneys and left liver lobe for the presence or absence of lesions

The celiac axis should be described for general arterial structure along with the aorta and superior mesenteric artery as well as the presence or absence of identifiable lymph nodes

Description of abnormal/pathological results:

Description of any tumor by the tumor, node, and metastasis system

Accurate detailing of the lesions and its surroundings in accordance with layers visualized by EUS

Degree of tumor penetration into organ mucosa and surrounding structures

Detailing the presence of lymph nodes when suspicious for malignancy and when performing FNA

Intra-procedural issues

Presence or absence of any mechanical problems or difficulties including past abdominal surgeries or ascites

Patient awakened/uncooperative during the procedure

Details of the number of FNAs performed with respective number of passes into each suspected lesion including:

Number of passes

Needle size

Number of needles

Impressions of aspirate (bloody, mucinous, color, etc.)

Cytology and/or histological examination

In-room tentative diagnosis

Post-procedural indicators

Summary of medical diagnoses

Examination findings, even if not relevant to the reason for EUS referral, should be listed

Physician recommendations shall be listed with respect to examination findings including instructions for the patient

Instructions for how patients will receive the results and for referring physician

After EUS, the incidence of adverse events should be listed, including pancreatitis, bleeding, and/or infections and the need for hospitalization

The above table is the standardized table of endoscopic ultrasound (EUS) quality indicators. This includes an itemized list for documentation prior to, during, and after performing EUS. FNA: Fine needle aspiration.