Corsi O, Martinez R, Aguirre J, Friedrich I, Galeno V, Jimenez V, Briones P, Díaz LA, Espino A, Vargas JI. Application of a novel adverse event classification scale in a Latin American gastrointestinal endoscopy unit. World J Gastrointest Endosc 2026; 18(1): 111384 [PMID: 41607391 DOI: 10.4253/wjge.v18.i1.111384]
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02445547
Submitted on:
January 15, 2026, 09:31
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Reader Comments:
I read with interest the study comparing the ASGE lexicon and the AGREE classification for adverse events in gastrointestinal endoscopy. The authors are to be commended for their rigorous analysis of a large institutional registry and for highlighting the conceptual differences between two widely used adverse event frameworks.
The high concordance observed between ASGE and AGREE confirms that both systems are robust for capturing clinically significant complications. However, the discordance noted for transient cardiorespiratory and sedation-related events raises an important interpretive issue. The ASGE lexicon intentionally captures such occurrences as “incidents,” supporting quality improvement and preventive strategies, whereas AGREE excludes many of these events by design, prioritising clinical consequence and post-procedural intervention. While this approach improves specificity, it may inadvertently narrow the safety signal.
From a patient-centred perspective, events such as inadequate sedation, procedural discomfort, or transient hypoxia—although self-limiting—can significantly influence patient-reported experience, satisfaction, and trust in endoscopic services. These experiential harms may not require escalation of care yet remain meaningful to patients and may affect willingness for repeat procedures. Their exclusion from adverse event datasets risks underestimating quality concerns that are increasingly relevant in value-based care.
The study also underscores that adverse event classification represents only one dimension of endoscopy quality. Domains such as procedural appropriateness, missed or delayed diagnoses, bowel preparation adequacy, photodocumentation quality, scheduling delays, and patient-initiated procedure termination are not captured by adverse event frameworks but are integral to comprehensive quality assessment.
In summary, while standardised adverse event classification remains essential for benchmarking and safety governance, it should be complemented by patient-reported experience measures and broader quality indicators. A multidimensional framework integrating safety, experience, and appropriateness may better align endoscopy quality metrics with contemporary patient-centred practice.