Endoscopic Ultrasound (EUS) Quality Indicators: What to Know About the 2025 American Standards

 

A new era in EUS: Setting the standards for quality

Endoscopic Ultrasound (EUS) has revolutionized the landscape of gastroenterology and hepatology. Originally introduced in the 1980s for cancer staging, it has since expanded into a powerful diagnostic and therapeutic tool. With this evolution, maintaining high-quality EUS practices has never been more important.
 
The American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG) have established rigorous quality indicators to ensure the safety, efficacy, and excellence of this procedure. At Bumrungrad International Hospital, we not only meet but often exceed these standards, positioning ourselves as a leader in EUS across Asia.
 

What is Endoscopic Ultrasound (EUS)?

EUS is a minimally invasive procedure that combines endoscopy and ultrasound to visualize and assess the digestive tract and nearby organs, such as the pancreas, liver, gallbladder, and lymph nodes. The high-resolution imaging from EUS helps in the early detection, diagnosis, staging, and even treatment of various gastrointestinal diseases.


Key functions of EUS

• Detailed imaging of internal structures
• Detection of tumors, cysts, gallstones, and inflammation
• Guided fine-needle aspiration (FNA) or biopsy (FNB)
• Therapeutic procedures (e.g., drainage of fluid collections, pain relief)

 

Why Quality Indicators Matter

High-quality EUS procedures ensure:

• Accurate diagnoses
• Minimally invasive yet effective treatments
• Reduction in complications and adverse events
• Optimal patient outcomes

The ASGE and ACG define quality in healthcare as the degree to which services increase the likelihood of desired outcomes and are consistent with current professional knowledge. These indicators are divided into pre-procedure, intra-procedure, and post-procedure metrics.
 

Quality Indicators for EUS (2025)

Pre-Procedure Indicators
1.Appropriate indication documented: >90%
2.Informed consent with risk discussion: >98%
3.Prophylactic antibiotics when indicated: >98%
4.Performed by credentialed endosonographer: >98%
 
Intra-Procedure Indicators
5.Documentation of relevant structures: >98%
6. Cancer staging using AJCC TNM system: >98%
7. Wall layer of origin for subepithelial lesions: >98%
8. Adequate EUS-guided liver biopsy sample: >85%
9. Detection of pancreatic mass ≥10mm: ≥90%
10. Documentation of cancer spread (nodes, liver, ascites): ≥90%
11. Diagnostic specimen in pancreatic mass biopsy: ≥87%
12. Success in pancreatic fluid collection drainage (PFCD): ≥92%

• This incisionless procedure uses EUS to safely drain pancreatic fluid collections—often caused by severe pancreatitis—into the stomach or small bowel, relieving pain, infection, and digestive symptoms without surgery.

13.Technical success in gallbladder drainage: >90%

• For patients who are not surgical candidates, EUS-guided gallbladder drainage offers a non-surgical solution, relieving pain and infection.

14.Technical success in biliary drainage: >85%

• In cases of bile duct obstruction, EUS-guided biliary drainage reroutes bile into the stomach or intestine, relieving jaundice and infection without open surgery.

15.Success in gastroenterostomy (EUS-GE): >85%

• This technique creates a bypass between the stomach and small intestine for patients with cancer-related bowel obstruction, restoring the ability to eat without surgery.

16.Success in EUS-directed transgastric ERCP (EDGE): >92%

• For patients who had gastric bypass surgery, the EDGE procedure provides access to the bypassed stomach or intestine using a safe, incisionless method via EUS.

17.Complete reporting of EUS procedure: >98%
 
Post-Procedure Indicators
18. Documentation of adverse events (AEs): >98%
19. AE Rates after diagnostic EUS:

• Perforation: <0.5%
• Infection: <1%
• Acute pancreatitis: <1%
• Bleeding: <1% (<5% after EUS-liver biopsy)

20.AE Rates after interventional EUS:

• PFCD: <10%
• Gallbladder drainage: <20%
• Biliary drainage: <25%
• EUS-GE/EDGE: <15%

Why Bumrungrad International Hospital?

1. Multidisciplinary Team Excellence
Bumrungrad is one of the few centers in Asia Pacific with a dedicated team of board-certified endosonographers, interventional endoscopists, hepatologists, radiologists, oncologists, pathologists, and surgeons collaborating closely for each case.
 
2. High Procedural Volume and Experience
High-volume centers are proven to deliver better outcomes. At Bumrungrad, our expert team performs EUS daily, including complex interventional cases like EUS-guided biliary drainage and pancreatic pseudocyst drainage.
 
3. World-Class Technology and Equipment
From state-of-the-art echoendoscopes to interventional EUS devices, our diagnostic accuracy and patient safety are second to none.
 
4. Credentialed Experts and International Recognition
Our EUS specialists are internationally trained and certified, having taught at global forums and authored major publications. One of our leading physicians chairs scientific sessions at Digestive Disease Week (DDW) and collaborates with ASGE.
 
5. Quality-Focused Culture
Our internal quality assurance processes mirror those defined by the ASGE/ACG and are benchmarked against global standards, with outcomes routinely audited.
 
6. Minimally Invasive, Maximally Effective
From EUS-guided liver biopsies to EUS-directed gastroenterostomy (EUS-GE), our goal is to provide effective alternatives to surgery that reduce patient recovery time, costs, and risk.
 
7. Research and Innovation Leadership
We actively participate in clinical research and innovation in the field of interventional EUS and pancreatic cancer screening, contributing to guideline development.

 

The Future of EUS — With You at the Center

As the capabilities of EUS expand—from staging cancer to treating gastric outlet obstruction non-surgically—so does the need for excellence. The 2025 American quality indicators are a roadmap for this journey. At Bumrungrad International Hospital, we follow this path not only in compliance but with distinction.


Book Your EUS Consultation Today
Trust your care to the institution that understands quality inside and out. At Bumrungrad, your health is in expert hands.
 
 
Tossapol Kerdsirichairat, MD, FACG, FASGE
Clinical Associate Professor of Medicine
Advanced/Bariatric Endoscopy, Digestive Disease Center
Bumrungrad International Hospital