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Canadian Association of Gastroenterology Practice Guideline for granting of privileges to perform gastrointestinal endoscopy.

The purpose of this statement is to provide guidelines to assist hospital credentialling committees in their task of granting privileges to perform gastrointestinal endoscopy. Endoscopy of the gastrointestinal tract has evolved over the past 30 years as a potent tool to assist in the evaluation, diagnosis and therapy of patients with gastrointestinal tract disorders. Although gastrointestinal endoscopy was initially developed as a purely diagnostic tool, the development of therapeutic endoscopic techniques has dramatically expanded the role of gastrointestinal endoscopy, frequently to a therapeutic one. In setting guidelines for training and credentialling one must recognize that, excluding flexible sigmoidoscopy, endoscopists should be well trained in therapeutic endoscopy. Competency in performing endoscopic procedures requires competency in the technical, interpretive and cognitive aspects of endoscopy, and the capability to integrate endoscopic findings into clinical practice. The six principals of endoscopic training are understanding of the indications; expeditious performance of procedures; correct interpretation of findings; integration of these findings into therapeutic management plans; avoidance and management of complications; and recognition of personal limitations in performing endoscopic procedures. Training should be comprehensive and provide a working knowledge of the pathophysiology, diagnosis and management of digestive diseases for which endoscopic procedures are indicated. Training and credentialling guidelines need to reflect the changes that have occurred in the field of gastrointestinal endoscopy. There is little need for the occasional endoscopist in Canada given the availability of well trained and experienced endoscopists throughout the country. It is clear that it is both care-effective and cost-effective for the Canadian public to have endoscopies performed by practitioners who are adequately trained, in centres that are appropriately equipped to handle the diagnostic and therapeutic aspects of these procedures. The following guidelines – in terms of training, credentialling and maintenance of competence – reflect these issues.