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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Application of a novel adverse event classification scale in a Latin American gastrointestinal endoscopy unit
Oscar Corsi, Richard Martinez, Joaquín Aguirre, Isidora Friedrich, Victoria Galeno, Vicente Jimenez, Pamela Briones, Luis Antonio Díaz, Alberto Espino, Jose Ignacio Vargas
Oscar Corsi, Richard Martinez, Luis Antonio Díaz, Alberto Espino, Jose Ignacio Vargas, Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330074, Chile
Joaquín Aguirre, Isidora Friedrich, Victoria Galeno, Vicente Jimenez, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330074, Chile
Pamela Briones, Unidad de Coloproctología, Complejo Asistencial Dr Sótero del Río, Servicio de Salud Metropolitano Sur Oriente, Santiago 8207257, Chile
Luis Antonio Díaz, MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, CA 92037, United States
Author contributions: Corsi O, Espino A, and Vargas J have made substantial contributions to conception and design; Corsi O, Aguirre J, Friedrich I, Galeno V, Jimenez V, and Briones P have made substantial contributions to the acquisition of data, and analysis; Corsi O, Espino A, and Vargas J have made substantial contributions to the interpretation of data; Corsi O, Martinez R, Aguirre J, Friedrich I, Galeno V, Jimenez V, Briones P, Díaz LA, Espino A, and Ignacio Vargas J have been involved in drafting the manuscript or revising it critically for important intellectual content; and all authors have seen and given final approval of the version to be submitted.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Pontificia Universidad Católica de Chile, approval No. 221206001.
Informed consent statement: All patients signed the informed consent form before procedures.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author, Vargas JI, upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jose Ignacio Vargas, MD, Assistant Professor, Department of Gas
troenterology, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago 8330074, Chile.
jivargasd@uc.cl
Received: July 1, 2025
Revised: September 17, 2025
Accepted: December 2, 2025
Published online: January 16, 2026
Processing time: 199 Days and 23.7 Hours
BACKGROUND
Accurate classification of adverse events (AEs) in gastrointestinal endoscopy is essential for safety monitoring and quality improvement. The American Society for Gastrointestinal Endoscopy (ASGE) lexicon is widely used, while the classification for AEs in gastrointestinal endoscopy (AGREE) is a recently proposed alternative aiming for broader applicability.
AIM
To compare the agreement and correlation between the AGREE and ASGE classification systems using real-world data from a Latin American academic endoscopy unit.
METHODS
A retrospective analysis of a prospective registry was conducted at a tertiary center in Chile, encompassing all endoscopy-related AEs from 2009 to 2022. Each AE was independently graded using both ASGE and AGREE classification systems by two blinded reviewers per system. Interobserver agreement was calculated using Cohen’s Kappa, and inter-scale correlation was assessed using Spearman’s rank test.
RESULTS
Of 176655 procedures performed, 235 AEs (0.13%) were included. Most events were related to therapeutic procedures, and the most common AEs were cardiorespiratory (42.1%), bleeding (20.9%), and perforation (17.0%). The ASGE system identified 42.1% of cases as incidents and 57.9% as AEs (Kappa = 0.83). AGREE classified 46.0% as non-AEs and 54.0% as AEs (Kappa = 0.74). A strong correlation between both systems was observed (ρ = 0.89; P < 0.001).
CONCLUSION
The AGREE classification strongly correlates with the ASGE lexicon but excludes more cases as non-AEs and shows slightly lower interobserver agreement. These findings support AGREE as a feasible alternative for AE grading in gastrointestinal endoscopy, particularly in diverse clinical environments.
Core Tip: The adverse events in gastrointestinal endoscopy (AGREE) classification is a recently proposed system for the classification of adverse events (AEs) in gastrointestinal endoscopy. There are scarce data about AEs in Latin American and no study has compared AGREE and American Society for Gastrointestinal Endoscopy classifications in our region. Using our prospective AEs registry, the AGREE classification shows a strong correlation with the American Society for Gastrointestinal Endoscopy lexicon, and excludes more cases as non-AEs. Our findings support the AGREE system as a feasible alternative for AEs grading in gastrointestinal endoscopy.
