Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Authors: Hey-Long Ching, Michelle S. Lau, Iman A. Azmy, Andrew D. Hopper, Martin Keuchel, Tibor Gyökeres, Roman Kuvaev, Elisabeth J. Macken, Pradeep Bhandari, Mo Thoufeeq, Philippe Leclercq, Matthew D. Rutter, Andrew M. Veitch, Raf Bisschops, David S. Sander


The European Society of Gastrointestinal Endoscopy and United European Gastroenterology have defined performance measures for upper and lower gastrointestinal, pancreaticobiliary, and small-bowel endoscopy. Quality indicators to guide endoscopists in the growing field of advanced endoscopy are also underway. We propose that equal attention is given to developing the entire advanced endoscopy team and not the individual endoscopist alone. We suggest that the practice of teams intending to deliver high quality advanced endoscopy is underpinned by six crucial principles concerning: selection, acceptance, complications, reconnaissance, envelopment, and documentation (SACRED)


Diagnostic endoscopy is well established with defined standards of practice [1–6]. In 2015, the European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) identified the quality of endoscopy as a major priority. This led to the commissioning of the ESGE Quality Improvement Committee (QIC) to develop performance measures for the domains of upper gastrointestinal (GI), lower GI, pancreaticobiliary, and small-bowel endoscopy, and for the endoscopy service [7]. Meanwhile, advanced therapeutic endoscopy is constantly evolving, with new techniques frequently emerging and progressively becoming more complex [8–10]. The development of quality indicators for advanced endoscopy is now also underway [11, 12]; however, there is a need to look beyond just the technical skills required of individual advanced endoscopists.

When delivering high quality endoscopy, the importance of nontechnical skills should be emphasized [13]. Good communication and decision-making skills are just as essential as the mechanical dexterity required for endoscopy. Moreover, training of the whole endoscopy team is as important as that for the individual endoscopist [14]. Advanced therapy is associated with a higher risk of adverse events (AEs) [15, 16]. Effective teamworking is crucial in high risk trades, as is evident in the aviation industry [17, 18], and is not a foreign concept to endoscopy services [19, 20]. Yet the notion of defining the model qualities of an endoscopy team has remained unexplored. In a burgeoning era of advanced therapeutics, ensuring that teams are equipped with the necessary repertoire of skills is more relevant than ever. In this Position Statement, we describe practical guidelines for building a team capable of mastering the challenges of advanced endoscopy. This process dedicates attention to six domains: selection, acceptance, complications, reconnaissance, envelopment, and documentation (SACRED).

Published online: 30.5.2022 | Endoscopy 2022; 54: 712–722
© European Society of Gastrointestinal Endoscopy