Application of a novel adverse event classification scale in a Latin American gastrointestinal endoscopy unit

Table 1 The American Society for Gastrointestinal Endoscopy and adverse events in gastrointestinal endoscopy categories for potential adverse events

ASGE		AGREE
Grading	Definition	Grading	Definition
Mild	Procedure aborted (or not started) because of an adverse event	No adverse event	A telephone contact with the general practitioner, outpatient clinic, or endoscopy service without any intervention
			Extended observation of the patient after the procedure, < 3 hours, without any intervention
	Postprocedure medical consultation	Grade I	Adverse events with any deviation of the standard postprocedural course, without the need for pharmacologic treatment or endoscopic, radiologic, or surgical interventions
	Unplanned hospital admission or prolongation of hospital stay for 3 nights		Presentation at the emergency ward, without any intervention
			Hospital admission (< 24 hours), without any intervention
			Allowed therapeutic regimens are drugs as antiemetics, antipyretics, analgesics, and electrolytes
			Allowed diagnostic tests: Radiology and laboratory tests
Moderate	Unplanned anesthesia/ventilation support, i.e., endotracheal intubation during conscious sedation	Grade II	Adverse events requiring pharmacologic treatment with drugs other than those allowed for grade I adverse events (i.e., antibiotics, antithrombotics, etc.)
	Unplanned admission or prolongation for 4-10 nights
	ICU admission for 1 night		Blood or blood product transfusions
	Transfusion		Hospital admission for more than 24 hours
	Repeat endoscopy for an adverse event	Grade III	Adverse events requiring endoscopic, radiologic, or surgical intervention
	Interventional radiology for an adverse event	Grade IIIa	Endoscopic or radiologic intervention
	Interventional treatment for integument injuries	Grade IIIb	Surgical intervention
Severe	Unplanned admission or prolongation for > 10 nights	Grade IV	Adverse events requiring intensive care unit/critical care unit admission
	ICU admission > 1 night	Grade IVa	Single-organ dysfunction (including dialysis)
	Surgery for an adverse event	Grade IVb	Multiorgan dysfunction
	Permanent disability (specify)
Fatal	Death	Grade V	Death of the patient

Modification from the study[6,8]. ASGE: American Society for Gastrointestinal Endoscopy; AGREE: Adverse events in gastrointestinal endoscopy; ICU: Intensive care unit.

Table 2 Frequencies of adverse events in gastrointestinal endoscopy categories for potential adverse events in diagnostic and therapeutic procedures, n (%)

AGREE categories	Diagnostic procedures (n = 114)	Therapeutic procedures (n = 121)
No adverse event	75 (65.79)	33 (27.73)
Grade I	6 (5.26)	3 (2.52)
Grade II	21 (18.42)	35 (29.41)
Grade III	9 (7.89)	35 (29.41)
Grade IV	2 (1.75)	3 (2.52)
Grade V	1 (0.88)	12 (10.08)

AGREE: Adverse events in gastrointestinal endoscopy.

Table 3 Comparison between the American Society for Gastrointestinal Endoscopy and adverse events in gastrointestinal endoscopy classification systems

Feature	ASGE lexicon	AGREE classification
Definition	An event that prevents completion of the planned procedure and/or results in admission to hospital, prolongation of existing hospital stay, another procedure (needing sedation/anesthesia), or subsequent medical consultation	A negative outcome for the patient that prevents completion of a planned procedure or causes any deviation from the standard postprocedural course
Severity categories	Mild, moderate, severe, fatal	Grades 1 to 5 (based on clinical impact, management, and outcome)
	Also, it qualifies for all events timing and attribution
Applicability	All gastrointestinal endoscopy procedures	All gastrointestinal endoscopy procedures
	Adopted historically	Should enable comparison between GI endoscopy and surgery or interventional radiology
	Focus on hospital admission and postprocedural interventions	Focus on postprocedural interventions
Origin	United States and Canada	Worldwide

ASGE: American Society for Gastrointestinal Endoscopy; AGREE: Adverse events in gastrointestinal endoscopy; GI: Gastrointestinal.