British Society of Gastroenterology, Association of Upper Gastrointestinal Surgery of Great Britain and Ireland and Royal College of Pathologists Delphi consensus guidance on biopsy sampling during upper gastrointestinal endoscopy in adult patients

These guidance statements represent a practical approach to tissue sampling in the upper gastrointestinal tract during endoscopy in adult patients, outlining instances when biopsies should and should not be taken. Analysis of data from the UK National Endoscopy Database has shown wide variations in biopsy practice among endoscopists. Endoscopy providers with high rates of post-endoscopy upper gastrointestinal cancer take more inappropriate and less appropriate biopsies during endoscopy. This guidance document was commissioned by the British Society of Gastroenterology (BSG) as part of its Upper Gastrointestinal Endoscopy Quality Improvement programme and developed in line with the BSG guidance methodology. A systematic literature review was performed to review the evidence base. However, due to the low quality of evidence in this area, application of GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was not possible and therefore Good Practice Statements, along with Expert Opinions, were used for recommendations. In total, 32 statements or recommendations were initially created and voted on by members of the Guidance Development Group on a five-point scale (strongly agree to strongly disagree). Statements achieving over 80% agreement were adopted. Following voting, one statement did not achieve consensus and was removed, and one statement was amended. All statements achieved over 80% agreement following a second round of voting. In formulating this guidance document, we hope that it will standardise biopsy practice for upper gastrointestinal endoscopy. Outlining when not to undertake tissue sampling will in turn reduce pressure on histopathology services, reduce costs in the National Health Service, and improve sustainability in endoscopy and pathology.