Standardization of quality in bariatric endoscopy: the BEQI framework and a simplified assessment tool (BEQI-S)

Resumen

Upper gastrointestinal endoscopy plays a central role in the preoperative assessment and postoperative follow-up of patients undergoing bariatric surgery. However, despite the increasing procedural volume and the complexity associated with surgically altered gastrointestinal anatomy, no specific validated quality indicators currently exist for this setting. This gap contributes to substantial variability in clinical practice and may impact diagnostic performance and patient safety. The aim of this study was to critically analyze the available evidence on quality in upper gastrointestinal endoscopy in bariatric surgery and to propose a structured framework of specific quality indicators. A structured narrative review was conducted based on a literature search in PubMed, LILACS, Embase, and the Cochrane Library (2015–2025), prioritizing clinical guidelines, position statements, and studies with methodological relevance and clinical applicability. Based on this synthesis, the Bariatric Endoscopy Quality Indicators (BEQI) framework was developed, organizing quality indicators across the pre-procedural, intra-procedural, and post-procedural phases, and integrating established endoscopic quality domains with bariatric-specific variables. In addition, a simplified tool (BEQI-S) was designed as a 13-item binary checklist, enabling a structured assessment of procedural quality and incorporating the concept of critical failures. The implementation of these indicators may contribute to standardizing clinical practice, improving diagnostic quality, enhancing patient safety, and facilitating audit and quality improvement processes. Prospective multicenter validation represents the next essential step to establish this model as a quality standard in bariatric endoscopy.