Clinical Endoscopy

Costs involved in compliance with new endoscope reprocessing guidelines: David Hoffman, Christina Cool; Clin Endosc 2024;57(4):534-541. Published online January 26, 2024; DOI: https://doi.org/10.5946/ce.2023.164

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: In March 2022, the Association for the Advancement of Medical Instrumentation (AAMI) released the American National Standards Institute (ANSI)/AAMI ST91:2021, their latest update on comprehensive, flexible, and semirigid endoscope reprocessing. These updated standards recommend the sterilization of high-risk endoscopes when possible and provide new recommendations for the precleaning, leak testing, manual cleaning, visual inspection, automated reprocessing, drying, storage, and transport of endoscopes.
Methods
ANSI/AAMI ST91:2021 was compared with ANSI/AAMI ST91:2015 for major reprocessing differences that result in either time and/or cost increases. Time estimates were captured by explicit recommendation inclusion or taken from the literature. All the costs were estimated using publicly available resources.
Results
The updated standards represent a potential 24.3-minute and 52.35 to 67.57 United States dollars increase per procedure in terms of reprocessing time and spending, respectively, not including capital investments. Capital costs per procedure were highly dependent on the procedure volume of the facility.
Conclusions
The new AAMI standards recommend several major changes, such as sterilization, for facilities to reprocess and manage endoscopes between uses. As more facilities increase their reprocessing methods to reflect the updated standards, they do so at a cost and introduce several delays. As the reprocessing landscape evolves, facilities should consider their true costs and alternative solutions, such as single-use endoscopes.

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International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy: Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee, The Korean Society of Gastrointestinal Endoscopy Task Force on Clinical Practice Guidelines; Clin Endosc 2024;57(2):141-157. Published online March 14, 2024; DOI: https://doi.org/10.5946/ce.2024.002

Abstract PDF PubReader ePub: Antithrombotic agents, including antiplatelet agents and anticoagulants, are widely used in Korea because of the increasing incidence of cardiocerebrovascular disease and the aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. The clinical practice guidelines for this issue, developed by the Korean Society of Gastrointestinal Endoscopy, were published in 2020. However, new evidence on the use of dual antiplatelet therapy and direct anticoagulant management has emerged, and revised guidelines have been issued in the United States and Europe. Accordingly, the previous guidelines were revised. Cardiologists were part of the group that developed the guideline, and the recommendations went through a consensus-reaching process among international experts. This guideline presents 14 recommendations made based on the Grading of Recommendations, Assessment, Development, and Evaluation methodology and was reviewed by multidisciplinary experts. These guidelines provide useful information that can assist endoscopists in the management of patients receiving antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

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Clinical practice guidelines for percutaneous endoscopic gastrostomy: Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy Task Force on Clinical Practice Guidelines; Clin Endosc 2023;56(4):391-408. Published online June 23, 2023; DOI: https://doi.org/10.5946/ce.2023.062

Abstract PDF Supplementary Material PubReader ePub

With an aging population, the number of patients with difficulty in swallowing due to medical conditions is gradually increasing. In such cases, enteral nutrition is administered through a temporary nasogastric tube. However, the long-term use of a nasogastric tube leads to various complications and a decreased quality of life. Percutaneous endoscopic gastrostomy (PEG) is the percutaneous placement of a tube into the stomach that is aided endoscopically and may be an alternative to a nasogastric tube when enteral nutritional is required for four weeks or more. This paper is the first Korean clinical guideline for PEG developed jointly by the Korean College of Helicobacter and Upper Gastrointestinal Research and led by the Korean Society of Gastrointestinal Endoscopy. These guidelines aimed to provide physicians, including endoscopists, with the indications, use of prophylactic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tube removal for PEG based on the currently available clinical evidence.

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Jun Woo Park, Tae Gyun Kim, Kwang Bum Cho, Jeong Seok Kim, Jin Woong Cho, Jung Won Jeon, Sun Gyo Lim, Chan Gyoo Kim, Hong Jun Park, Tae Jun Kim, Eun Sun Kim, Su Jin Jeong, Yong Hwan Kwon
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Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition: Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo Young Cho, Moon Sung Lee, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases; Clin Endosc 2022;55(6):703-725. Published online October 13, 2022; DOI: https://doi.org/10.5946/ce.2022.136

Abstract PDF Supplementary Material PubReader ePub

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for the management of advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: (1) adenoma ≥10 mm in size; (2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adenoma; (6) sessile serrated lesion (SSL) containing any grade of dysplasia; (7) serrated polyp of at least 10 mm in size; and (8) 3 to 5 (or more) SSLs. More studies are needed to fully comprehend the patients most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

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Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
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Quality indicators in esophagogastroduodenoscopy: Sang Yoon Kim, Jae Myung Park; Clin Endosc 2022;55(3):319-331. Published online May 16, 2022; DOI: https://doi.org/10.5946/ce.2022.094

Abstract PDF PubReader ePub

Esophagogastroduodenoscopy (EGD) has been used to diagnose a wide variety of upper gastrointestinal diseases. In particular, EGD is used to screen high-risk subjects of gastric cancer. Quality control of EGD is important because the diagnostic rate is examiner-dependent. However, there is still no representative quality indicator that can be uniformly applied in EGD. There has been growing awareness of the importance of quality control in improving EGD performance. Therefore, we aimed to review the available and emerging quality indicators for diagnostic EGD.

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Sistema de auditoría automática para la exploración endoscópica del estómago con Inteligencia Artificial – Gastro UNAL: Gastroendoscopy UNit for Automatic Labeling
Martín Alonso Gómez Zuleta, Diego Fernando Bravo Higuera, Josué Andre Ruano Balseca, María Jaramillo González, Fabio Augusto González Osorio, Edgar Eduardo Romero Castro
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Bruno Costa Martins, Renata Nobre Moura, Angelo So Taa Kum, Carolina Ogawa Matsubayashi, Sergio Barbosa Marques, Adriana Vaz Safatle-Ribeiro
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Hui Li, Hui Hu, Ping Geng, Panhui Guo, Yuanrong Zhu, Lulu Zeng, Jun Liu, Xiangpeng Hu
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Akash Roy, Mahesh K. Goenka
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Caesar Ferrari, Micheal Tadros
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Hyun Young Kim
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Perception of Gastrointestinal Endoscopy Personnel on Society Recommendations on Personal Protective Equipment, Case Selection, and Scope Cleaning During Covid-19 Pandemic: An International Survey Study: Parit Mekaroonkamol, Kasenee Tiankanon, Rapat Pittayanon, Wiriyaporn Ridtitid, Fariha Shams, Ghias Un Nabi Tayyab, Julia Massaad, Saurabh Chawla, Stanley Khoo, Siriboon Attasaranya, Nonthalee Pausawasdi, Qiang Cai, Thawee Ratanachu-ek, Pradermchai Kongkham, Rungsun Rerknimitr; Clin Endosc 2022;55(2):215-225. Published online September 29, 2021; DOI: https://doi.org/10.5946/ce.2021.051

Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: The Thai Association for Gastrointestinal Endoscopy published recommendations on safe endoscopy during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the practicality and applicability of the recommendations and the perceptions of endoscopy personnel on them.
Methods
A validated questionnaire was sent to 1290 endoscopy personnel globally. Of these, the data of all 330 responders (25.6%) from 15 countries, related to the current recommendations on proper personal protective equipment (PPE), case selection, scope cleaning, and safety perception, were analyzed. Ordinal logistic regression was used to determine the relationships between the variables.
Results
Despite an overwhelming agreement with the recommendations on PPE (94.5%) and case selection (95.5%), their practicality and applicability on PPE recommendations and case selection were significantly lower (p=0.001, p=0.047, p<0.001, and p=0.032, respectively). Factors that were associated with lower sense of safety in endoscopy units were younger age (p=0.004), less working experience (p=0.008), in-training status (p=0.04), and higher national prevalence of COVID-19 (p=0.003). High prevalent countries also had more difficulty implementing the guidelines (p<0.001) and they considered the PPE recommendations less practical and showed lower agreement with them (p<0.001 and p=0.008, respectively). A higher number of in-hospital COVID-19 patients was associated with less agreement with PPE recommendations (p=0.039).
Conclusions
Using appropriate PPE and case selection in endoscopic practice during a pandemic remains a challenge. Resource availability and local prevalence are critical factors influencing the adoption of the current guidelines.

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2021 Korean Society of Gastrointestinal Endoscopy Clinical Practice Guidelines for Endoscopic Sedation: Hong Jun Park, Byung-Wook Kim, Jun Kyu Lee, Yehyun Park, Jin Myung Park, Jun Yong Bae, Seung Young Seo, Jae Min Lee, Jee Hyun Lee, Hyung Ku Chon, Jun-Won Chung, Hyun Ho Choi, Myung Ha Kim, Dong Ah Park, Jae Hung Jung, Joo Young Cho, Endoscopic Sedation Committee of Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2022;55(2):167-182. Published online February 22, 2022; DOI: https://doi.org/10.5946/ce.2021.282

Abstract PDF Supplementary Material PubReader ePub

Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Cardiopulmonary complications are usually temporary. Most patients recover without sequelae. However, they may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk.

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Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections: Chi Hyuk Oh, Jun Kyu Lee, Tae Jun Song, Jin-Seok Park, Jae Min Lee, Jun Hyuk Son, Dong Kee Jang, Miyoung Choi, Jeong-Sik Byeon, In Seok Lee, Soo Teik Lee, Ho Soon Choi, Ho Gak Kim, Hoon Jai Chun, Chan Guk Park, Joo Young Cho; Clin Endosc 2021;54(4):505-521. Published online July 27, 2021; DOI: https://doi.org/10.5946/ce.2021.185

Abstract PDF PubReader ePub

Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to develope medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies.

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Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE): Moon Jae Chung, Se Woo Park, Seong-Hun Kim, Chang Min Cho, Jun-Ho Choi, Eun Kwang Choi, Tae Hoon Lee, Eunae Cho, Jun Kyu Lee, Tae Jun Song, Jae Min Lee, Jun Hyuk Son, Jin Suk Park, Chi Hyuk Oh, Dong-Ah Park, Jeong-Sik Byeon, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun, Ho Soon Choi, Chan Guk Park, Joo Young Cho; Clin Endosc 2021;54(2):161-181. Published online March 24, 2021; DOI: https://doi.org/10.5946/ce.2021.069

Abstract PDF PubReader ePub

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in 8 categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

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Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy: Hyun Lim, Eun Jeong Gong, Byung-Hoon Min, Seung Joo Kang, Cheol Min Shin, Jeong-Sik Byeon, Miyoung Choi, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun; Clin Endosc 2020;53(6):663-677. Published online November 26, 2020; DOI: https://doi.org/10.5946/ce.2020.192

Abstract PDF PubReader ePub

Antithrombotic agents, including antiplatelet agents and anticoagulants, are increasingly used in South Korea. The management of patients using antithrombotic agents and requiring gastrointestinal endoscopy is an important clinical challenge. Although clinical practice guidelines (CPGs) for the management of patients receiving antithrombotic agents and undergoing gastrointestinal endoscopy have been developed in the Unites States, Europe, and Asia Pacific region, it is uncertain whether these guidelines can be adopted in South Korea. After reviewing current CPGs, we identified unmet needs and recognized significant discrepancies in the clinical practice among regions. This is the first CPG in Korea providing information that may assist endoscopists in the management of patients on antithrombotic agents who require diagnostic or elective therapeutic endoscopy. This guideline was developed through the adaptation process as an evidence-based method, with four guidelines retrieved by systematic review. Eligible guidelines were evaluated according to the Appraisal of Guidelines for Research and Evaluation II process, and 13 statements were established using a grading system. This guideline was reviewed by external experts before an official. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

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Gut and Liver.2024; 18(1): 10. CrossRef
A systematic critical appraisal of clinical practice guidelines of antithrombotic agents in gastrointestinal endoscopy using the AGREE II tool
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The Impact of Sedation on Cardio-Cerebrovascular Adverse Events after Surveillance Esophagogastroduodenoscopy in Patients with Gastric Cancer: A Nationwide Population-Based Cohort Study
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Gut and Liver.2024; 18(2): 245. CrossRef
International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
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Multidisciplinary and Multisociety Practice Guideline on Reprocessing Flexible Gastrointestinal Endoscopes and Endoscopic Accessories: Dae Young Cheung, Byung Ik Jang, Sang Wook Kim, Jie-Hyun Kim, Hyung Keun Kim, Jeong Eun Shin, Won Jae Yoon, Yong Kang Lee, Kwang Hyun Chung, Soo-Jeong Cho, Hyun Phil Shin, Sun Young Cho, Woon Geon Shin, Kee Don Choi, Byung-Wook Kim, Joong Goo Kwon, Hee Chan Yang, Tae-Geun Gweon, Hyun Gun Kim, Dong-Won Ahn, Kwang Bum Cho, Sun Hee Kim, Kyong Hwa Hwang, Hee Hyuk Im; Clin Endosc 2020;53(3):276-285. Published online May 29, 2020; DOI: https://doi.org/10.5946/ce.2020.106

Abstract PDF PubReader ePub

The area of endoscopic application has been continuously expanded since its introduction in the last century and the frequency of its use also increased stiffly in the last decades. Because gastrointestinal endoscopy is naturally exposed to diseased internal organs and contact with pathogenic materials, endoscopy mediated infection or disease transmission becomes a major concern in this field. Gastrointestinal endoscopy is not for single use and the proper reprocessing process is a critical factor for safe and reliable endoscopy procedures. What needed in these circumstances is a practical guideline for reprocessing the endoscope and its accessories which is feasible in the real clinical field to guarantee acceptable prevention of pathogen transmission. This guideline contains principles and instructions of the reprocessing procedure according to the step by step. And it newly includes general information and updated knowledge about endoscopy-mediated infection and disinfection. Multiple societies and working groups participated to revise; Korean Association for the Study of the Liver, the Korean Society of Infectious Diseases, Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Society of Gastroenterology, Korean Society of Gastrointestinal Cancer, Korean Association for the Study of Intestinal Diseases, Korean Pancreatobiliary Association, the Korean Society of Gastrointestinal Endoscopy Nurses and Associates and Korean Society of Gastrointestinal Endoscopy. Through this cooperation, we enhanced communication and established a better concordance. We still need more researches in this field and fill up the unproven area. And our guidelines will be renewed accordingly.

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Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer: Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong Yeul Lee, Jeong-Sik Byeon, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Hoon Jai Chun; Clin Endosc 2020;53(2):142-166. Published online March 30, 2020; DOI: https://doi.org/10.5946/ce.2020.032

Abstract PDF Supplementary Material PubReader ePub

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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Education and Training Guidelines for the Board of the Korean Society of Gastrointestinal Endoscopy: Hee Seok Moon, Eun Kwang Choi, Ji Hyun Seo, Jeong Seop Moon, Ho June Song, Kyoung Oh Kim, Jong Jin Hyun, Sung Kwan Shin, Beom Jae Lee, Sang Heon Lee; Clin Endosc 2017;50(4):345-356. Published online July 31, 2017; DOI: https://doi.org/10.5946/ce.2017.106

Abstract PDF PubReader ePub

The Korean Society of Gastrointestinal Endoscopy (KSGE) developed a gastrointestinal (GI) endoscopy board in 1995 and related regulations. Although the KSGE has acquired many specialists since then, the education and training aims and guidelines were insufficient. During GI fellowship training, obtaining sufficient exposure to some types of endoscopic procedures is difficult. Fellows should acquire endoscopic skills through supervised endoscopic procedures during GI fellowship training. Thus, the KSGE requires training guidelines for fellowships that allow fellows to perform independent endoscopic procedures without supervision. This document is intended to provide principles that the Committee of Education and Training of the KSGE can use to develop practical guidelines for granting privileges to perform accurate GI endoscopy safely. The KSGE will improve the quality of GI endoscopy by providing guidelines for fellowships and supervisors.

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Korean Society of Gastrointestinal Endoscopy Guidelines for Endoscope Reprocessing: Byoung Kwan Son, Byung-Wook Kim, Won Hee Kim, Dae-Sung Myung, Young-Seok Cho, Byung Ik Jang, The Disinfection Management and Conscious Sedation Committee of Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2017;50(2):143-147. Published online March 17, 2017; DOI: https://doi.org/10.5946/ce.2017.029

Abstract PDF PubReader ePub

The Korean Society of Gastrointestinal Endoscopy (KSGE) issued guidelines for endoscope reprocessing for the first time in 1995, and the version of the guidelines was updated in August 2009, August 2012, and March 2015. Guidelines for endoscope reprocessing should be revised continuously, because new disinfectants and devices are developed and introduced. The current official version of the KSGE guidelines for endoscope reprocessing is explained herein to assist the reader in understanding the KSGE requirements for cleaning and disinfecting endoscopes.

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Considerable Variability of Procedural Sedation and Analgesia Practices for Gastrointestinal Endoscopic Procedures in Europe: Hermanus H. B. Vaessen, Johannes T. A. Knape; Clin Endosc 2016;49(1):47-55. Published online January 28, 2016; DOI: https://doi.org/10.5946/ce.2016.49.1.47

Abstract PDF PubReader ePub

Background
/Aims: The use of moderate to deep sedation for gastrointestinal endoscopic procedures has increased in Europe considerably. Because this level of sedation is a risky medical procedure, a number of international guidelines have been developed. This survey aims to review if, and if so which, quality aspects have been included in new sedation practices when compared to traditional uncontrolled sedation practices.
Methods
A questionnaire was sent to the National Associations of Nurse Anesthetists in Europe and the National Delegates of the European Section and Board of Anaesthesiology from January 2012 to August 2012.
Results
Huge variation in practices for moderate to deep sedation were identified between and within European countries in terms of safety, type of practitioners, responsibilities, monitoring, informed consent, patient satisfaction, complication registration, and training requirements. Seventy-five percent of respondents were not familiar with international sedation guidelines. Safe sedation practices (mainly propofol-based moderate to deep sedation) are rapidly gaining popularity.
Conclusions
The risky medical procedure of moderate to deep sedation has become common practice for gastrointestinal endoscopy. Safe sedation practices requiring adequate selection of patients, adequate monitoring, training of sedation practitioners, and adequate after-care, are gaining attention in a field that is in transition from uncontrolled sedation care to controlled sedation care.

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Clinical Practice Guidelines for Endoscope Reprocessing: Hyun Jin Oh, Jin Su Kim; Clin Endosc 2015;48(5):364-368. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.364

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Gastrointestinal endoscopy is effective and safe for the screening, diagnosis, and treatment of gastrointestinal disease. However, issues regarding endoscope-transmitted infections are emerging. Many countries have established and continuously revise guidelines for endoscope reprocessing in order to prevent infections. While there are common processes used in endoscope reprocessing, differences exist among these guidelines. It is important that the reprocessing of gastrointestinal endoscopes be carried out in accordance with the recommendations for each step of the process.

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Guidelines for Video Capsule Endoscopy: Emphasis on Crohn's Disease: Soo-Kyung Park, Byong Duk Ye, Kyeong Ok Kim, Cheol Hee Park, Wan-Sik Lee, Byung Ik Jang, Yoon Tae Jeen, Myung-Gyu Choi, Hyun Jung Kim, The Korean Gut Image Study Group; Clin Endosc 2015;48(2):128-135. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.128

Abstract PDF PubReader ePub

Video capsule endoscopy (VCE) is an ingestible video camera that transmits high-quality images of the small intestinal mucosa. This makes the small intestine more readily accessible to physicians investigating the presence of small bowel disorders, such as Crohn's disease (CD). Although VCE is frequently performed in Korea, there are no evidence-based guidelines on the appropriate use of VCE in the diagnosis of CD. To provide accurate information and suggest correct testing approaches for small bowel diseases, the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy, developed guidelines on VCE. Teams were set up to develop guidelines on VCE. Four areas were selected: diagnosis of obscure gastrointestinal bleeding, small bowel preparation for VCE, diagnosis of CD, and diagnosis of small bowel tumors. Three key questions were selected regarding the role of VCE in CD. In preparing these guidelines, a systematic literature search, evaluation, selection, and meta-analysis were performed. After writing a draft of the guidelines, the opinions of various experts were solicited before producing the final document. These guidelines are expected to play a role in the diagnosis of CD. They will need to be updated as new data and evidence become available.

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Gary R Lichtenstein, Edward V Loftus, Kim L Isaacs, Miguel D Regueiro, Lauren B Gerson, Bruce E Sands
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Endoscopic Sedation: From Training to Performance: Tae Hoon Lee, Chang Kyun Lee; Clin Endosc 2014;47(2):141-150. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.141

Abstract PDF PubReader ePub

Adequate sedation and analgesia are considered essential requirements to relieve patient discomfort and pain and ultimately to improve the outcomes of modern gastrointestinal endoscopic procedures. The willingness of patients to undergo sedation during endoscopy has increased steadily in recent years and standard sedation practices are needed for both patient safety and successful procedural outcomes. Therefore, regular training and education of healthcare providers is warranted. However, training curricula and guidelines for endoscopic sedation may have conflicts according to varying legal frameworks and/or social security systems of each country, and well-recognized endoscopic sedation training systems are not currently available in all endoscopy units. Although European and American curricula for endoscopic sedation have been extensively developed, general curricula and guidelines for each country and institution are also needed. In this review, an overview of recent curricula and guidelines for training and basic performance of endoscopic sedation is presented based on the current literature.

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Su Jung Han, Tae Hoon Lee, Sang‐Heum Park, Young Sin Cho, Yun Nah Lee, Yunho Jung, Hyun Jong Choi, Il‐Kwun Chung, Sang‐Woo Cha, Jong Ho Moon, Young Deok Cho, Sun‐Joo Kim
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Guidelines for Bowel Preparation before Video Capsule Endoscopy: Hyun Joo Song, Jeong Seop Moon, Jae Hyuk Do, In Hye Cha, Chang Hun Yang, Myung-Gyu Choi, Yoon Tae Jeen, Hyun Jung Kim; Clin Endosc 2013;46(2):147-154. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.147

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The preparation for video capsule endoscopy (VCE) of the bowel suggested by manufacturers of capsule endoscopy systems consists only of a clear liquid diet and an 8-hour fast. While there is evidence for a benefit from bowel preparation for VCE, so far there is no domestic consensus on the preparation regimen in Korea. Therefore, we performed this study to recommend guidelines for bowel preparation before VCE. The guidelines on VCE were developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. Four key questions were selected. According to our guidelines, bowel preparation with polyethylene glycol (PEG) solution enhances small bowel visualization quality (SBVQ) and diagnostic yield (DY), but it has no effect on cecal completion rate (CR). Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR of VCE. Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE.

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Guideline for Capsule Endoscopy: Obscure Gastrointestinal Bleeding: Ki-Nam Shim, Jeong Seop Moon, Dong Kyung Chang, Jae Hyuk Do, Ji Hyun Kim, Byung Hoon Min, Seong Ran Jeon, Jin-Oh Kim, Myung-Gyu Choi, Korean Gut Image Study Group; Clin Endosc 2013;46(1):45-53. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.45

Abstract PDF PubReader ePub

Capsule endoscopy (CE) is considered as a noninvasive and reliable diagnostic tool of examining the entire small bowel. CE has been performed frequently at many medical centers in South Korea; however, there is no evidence-based CE guideline for adequate diagnostic approaches. To provide accurate information and suggest correct testing approaches for small bowel disease, the guideline on CE was developed by the Korean Gut Image Study Group, a part of the Korean Society of Gastrointestinal Endoscopy. Operation teams for developing the guideline were organized into four areas: obscure gastrointestinal bleeding, small bowel preparation, Crohn's disease, and small bowel tumor. A total of 20 key questions were selected. In preparing this guideline, MEDLINE, Cochrane library, KMbase, KISS, and KoreaMed literature searches were performed. After writing a draft of the guideline, opinions from various experts were reflected before approving the final document. The guideline should be regarded as recommendations only to gastroenterologists in providing care to their patients. These are not absolute rules and should not be construed as establishing a legal standard of care. Although further revision may be necessary as new data appear, this guideline is expected to play a role for adequate diagnostic approaches of various small bowel diseases.

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Korean Guideline for Colonoscopic Polypectomy: Suck-Ho Lee, Sung Jae Shin, Dong Il Park, Seong-Eun Kim, Hae Jeong Jeon, Se Hyung Kim, Sung Pil Hong, Sung Noh Hong, Dong-Hoon Yang, Bo In Lee, Young-Ho Kim, Hyun-Soo Kim, Hyun Jung Kim, Suk-Kyun Yang, Hyo Jong Kim, Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management; Clin Endosc 2012;45(1):11-24. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.11

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There is indirect evidence to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary outpatient clinics and secondary and tertiary medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, PubMed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient's condition and the available courses of action.

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Korean Guidelines for Colorectal Cancer Screening and Polyp Detection: Bo-In Lee, Sung Pil Hong, Seong-Eun Kim, Se Hyung Kim, Hyun-Soo Kim, Sung Noh Hong, Dong-Hoon Yang, Sung Jae Shin, Suck-Ho Lee, Dong Il Park, Young-Ho Kim, Hyun Jung Kim, Suk-Kyun Yang, Hyo Jong Kim, Hae Jeong Jeon, Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management; Clin Endosc 2012;45(1):25-43. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.25

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Now colorectal cancer is the second most common cancer in males and the fourth most common cancer in females in Korea. Since most of colorectal cancers occur after the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. The guideline was developed by the Korean Multi-Society Take Force and we tried to establish the guideline by evidence-based methods. Parts of the statements were draw by systematic reviews and meta-analyses. Herein we discussed epidemiology of colorectal cancers and adenomas in Korea and optimal methods for screening of colorectal cancer and detection of adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.

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Korean Guidelines for Postpolypectomy Colonoscopy Surveillance: Dong-Hoon Yang, Sung Noh Hong, Young-Ho Kim, Sung Pil Hong, Sung Jae Shin, Seong-Eun Kim, Bo In Lee, Suck-Ho Lee, Dong Il Park, Hyun-Soo Kim, Suk-Kyun Yang, Hyo Jong Kim, Se Hyung Kim, Hyun Jung Kim, Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management; Clin Endosc 2012;45(1):44-61. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.44

Abstract PDF Supplementary Material PubReader ePub

Postpolypectomy surveillance has become a major indication for colonoscopy as a result of increased use of screening colonoscopy in Korea. In this report, a careful analytic approach was used to address all available evidences to delineate the predictors for advanced neoplasia at surveillance colonoscopy and we elucidated the high risk findings of the index colonoscopy as follows: 3 or more adenomas, any adenoma larger than 10 mm, any tubulovillous or villous adenoma, any adenoma with high-grade dysplasia, and any serrated polyps larger than 10 mm. Surveillance colonoscopy should be performed five years after the index colonoscopy for those without any high-risk findings and three years after the index colonoscopy for those with one or more high risk findings. However, the surveillance interval can be shortened considering the quality of the index colonoscopy, the completeness of polypectomy, the patient's general condition, and family and medical history.

Citations

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Postpolypectomy Surveillance Guidelines of US and Europe: Dong-Hoon Yang, M.D.; Korean J Gastrointest Endosc 2010;42(50):244-251. Published online March 27, 2010

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Introduction of Proposed Guideline for Endoscopy Disinfection: Yong-Tae Kim, M.D., Ph.D.; Korean J Gastrointest Endosc 2010;42(8):49-49. Published online March 27, 2010

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Education and Training Guidelines for the Board of the Korean Society of Gastrointestinal Endoscopy: Kee Myung Lee, M.D., Seok Reyol Choi, M.D.*, Byung Ik Jang, M.D.^†, Seong Hwan Kim, M.D.^‡, Chang Don Kang, M.D.^§, Young Dae Kim, M.D.^∥, Jeong Youp Park, M.D.^¶ and Il-Kwun Ch; Korean J Gastrointest Endosc 2011;42(4):207-214. Published online April 28, 2011

Abstract PDF: The Korean Society of Gastrointestinal Endoscopy (KSGE) developed regulations and a gastrointestinal endoscopy board in 1995. Although the KSGE has acquired many specialists since then, the education and training aims and guidelines were insufficient. Although endoscopic examinations are supervised by a specialist during a GI fellowship, some types of GI endoscopic examinations and treatments are difficult to obtain exposure. Fellows should acquire endoscopic skills through repeated independent endoscopic examinations after a GI fellowship. Thus, the KSGE requires training guidelines for fellowships that allow fellows to perform endoscopic examinations without a supervisor. This document is intended to provide the principles that the Committee of Education and Training of KSGE can use to develop practical guidelines for granting privileges to perform accurate GI endoscopy safely. KSGE will contribute to improving the quality of GI endoscopy by providing guidelines for fellowships and supervisors. (Korean J Gastrointest Endosc 2011;42:207-214)

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Conscious Sedation During Gastrointestinal Endoscopy: Midazolam vs Propofol: Ja Seol Koo, M.D. and Jai Hyun Choi, M.D.; Korean J Gastrointest Endosc 2011;42(2):67-73. Published online February 28, 2011

Abstract PDF: Endoscopy is increasingly performed with the patient under conscious sedation in many countries. The majority of patients can be adequately and safely sedated during routine upper endoscopy and colonoscopy with a combination of a benzodiazepine and opioid. Midazolam is a water-soluble benzodiazepine that is characterized by a rapid onset of action and a shorter duration compared with that of the other drugs of the same class. The major side effect of midazolam is respiratory depression, which can be reversed by flumazenil, a benzodiazepine-specific antagonist. Propofol is a lipid-soluble agent that has the advantages of a more rapid onset of action and a shorter recovery time compared to that of midazolam. However, it should be used with caution since it can lead to hypotension and respiratory depression. Propofol can be safely and effectively administered by nonanesthesiology physicians and nurses provided that they have received adequate training. Two models have been proposed for the administration of propofol by endoscopists: nurse-administered propofol sedation (NAPS) and combination propofol (propofol plus other agents) sedation. In order to modify the pharmacological disadvantages of propofol, fospropofol sodium, a water-soluble prodrug of propofol, has recently been developed. In addition, new delivery systems have been devised: patient-controlled sedation and computer-assisted personalized sedation, in which the computer continuously monitors the patient's condition and adjusts the dose of propofol accordingly. Endoscopists must have a thorough understanding of the medications used for endoscopic sedation and they must acquire the skills necessary for the treatment of cardiopulmonary complications. Therefore, it is necessary to develop a practice guideline pertaining to endoscopic sedation and also training programs for physicians and nurses in Korea. (Korean J Gastrointest Endosc 2011;42:67-73)

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Postpolypectomy Colonoscopy Surveillance: Hyun Soo Kim, M.D.; Korean J Gastrointest Endosc 2009;39(5):257-264. Published online November 30, 2009

Abstract PDF: Colonoscopy and polypectomy are increasingly being used as the most effective interventions for preventing colorectal cancer (CRC), which has resulted in a growing cohort of patients who require postpolypectomy surveillance (PPS). The goal of PPS is to prevent the development of significant metachronous adenomas and CRCs. The surveillance interval depends on an accurate assessment of the individual patient's risk of developing subsequent colonic neoplasm. The newly developed consensus guidelines (CG) emphasize the concept of 'risk stratification' and these guidelines are more user-friendly than the previous ones, thus eliminate conflicting recommendations that are a barrier to physicians using the guideline. Despite the development of CGs, many specialists and non-specialists overutilize colonoscopy for PPS, which causes an ineffective large burden of cost and it strains already limited resources. The safest and most cost-effective approach by colonoscopists to preventing CRC is to maximize the effectiveness of colonoscopy for clearing the colon and then follow the recommended intervals between procedures, including extended intervals for the low-risk cohorts. Educating colonoscopists and the widespread implementation of continuous quality improvement programs are required to bridge the gap between the guidelines and their clinical application. (Korean J Gastrointest Endosc 2009;39:257-264)

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Korean Society of Gastrointestinal Endoscopy (KSGE) Guidelines for Credentialing and Granting Previleges for Capsule Endoscopy: Gut Image Study Group: Yun Jeong Lim, M.D., Jeong Seop Moon, M.D.*, Dong Kyung Chang, M.D.^†, Byung Ik Jang, M.D.^‡, Hoon Jai Chun, M.D.^§ and Myung-Gyu Choi, M.D.^∥; Korean J Gastrointest Endosc 2008;37(6):393-402. Published online December 30, 2008

Abstract PDF: Capsule endoscope is self-contained videoendoscopy device that transmit images of the gastrointestinal tract to an external receiver. Capsule endoscopy has become a very important tool for diagnosing of small bowel disorders. Upcoming capsule endoscopy techniques for the investigation of esophageal, stomach, and colon may render it promising technique for these organs as well. This document is intended to provide the principles by which credentialing organizations may create practical guidelines for granting privileges to perform capsule endoscopy. KSGE recommends that the use of capsule endoscopy be limited to practitioners already competent and privileged to perform standard upper and lower endoscopy and who have extensive experience viewing gastrointestinal mucosa. KSGE recommends additional specific training in capsule endoscopy as well as review of the 20 procedures to verify competence. KSGE also admitted formal fellowship training having a familiarity with the hardware and software systems and interpretation of the at least 10 cases under the supervision of professor in capsule endoscopy during GI fellowship. (Korean J Gastrointest Endosc 2008;37:393-402)

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