Letter to the Editor: Adverse event classification in gastrointestinal endoscopy

Abstract

Standardized reporting of endoscopy-related adverse events (AE) remains challenging. Definitions, severity thresholds, and attribution windows vary across units, and documentation practices substantially influence observed event rates. A recent registry-based comparison of two AE classification systems illustrates that strong concordance in severity grading does not, in itself, resolve implementation challenges at the boundary between incidents and non-events, nor does it address under-ascertainment. In this letter, we trace the evolution of endoscopy AE nomenclature, from earlier documentation-intensive approaches to contemporary frameworks that prioritize clinical consequence and treatment-based grading. Drawing on external real-world validation data and published commentaries, we argue that endoscopy units should prioritize a dual-stream safety framework: Severity-graded adverse-event reporting for clinically consequential harms, alongside structured capture of incidents and near-misses for prevention-oriented learning. We further highlight the need for procedure-stratified interpretation, explicit documentation of local post-procedural pathways, robust ascertainment workflows, and separate monitoring of diagnostic delay and procedural appropriateness.

Keywords: Adverse event; Colonoscopy; Endoscopy; Gastroscopy; Healthcare quality; Patient safety

Core Tip: Adverse event (AE) grading is useful only when paired with robust documentation and a clear review pathway. A practical model is to track AEs for benchmarking while retaining an incident or near-miss stream for prevention signals, and to measure diagnostic delay and procedural appropriateness with separate indicators rather than forcing them into AE registries.