Clinical Endoscopy

Reviews

Revision of Quality Indicators for the Endoscopy Quality Improvement Program of the National Cancer Screening Program in Korea: Jun Ki Min, Jae Myung Cha, Yu Kyung Cho, Jie-Hyun Kim, Soon Man Yoon, Jong Pil Im, Yunho Jung, Jeong Seop Moon, Jin-Oh Kim, Yoon Tae Jeen; Clin Endosc 2018;51(3):239-252. Published online May 31, 2018; DOI: https://doi.org/10.5946/ce.2018.075

Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.

Citations

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Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition
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Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition
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Colonoscopy quality in community hospitals and nonhospital facilities in Korea
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The Korean Journal of Internal Medicine.2021; 36(Suppl 1): S35. CrossRef
Association of Regular Endoscopic Screening with Interval Gastric Cancer Incidence in the National Cancer Screening Program
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Youn I Choi, Jong-Joon Lee, Jun-Won Chung, Kyoung Oh Kim, Yoon Jae Kim, Jung Ho Kim, Dong Kyun Park, Kwang An Kwon
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Tae Hee Lee, Jin Young Yoon, Chang Nyol Paik, Hyuk Soon Choi, Jae-Young Jang
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Quality Indicators and Outcome Measures of Endoscopy in the National Cancer Screening Program
Jun Ki Min, Jae Myung Cha, Min Seob Kwak, Jin Young Yoon, Yunho Jung, Jeong Eun Shin, Hyo-Joon Yang
Yonsei Medical Journal.2019; 60(11): 1054. CrossRef

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How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program: Yu Kyung Cho; Clin Endosc 2016;49(4):312-317. Published online July 29, 2016; DOI: https://doi.org/10.5946/ce.2016.084

Abstract PDF PubReader ePub

In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.

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Simethicone and N-acetyl cysteine combination as premedication before esophagogastroduodenoscopy: Double-blind randomized controlled trial
Veeraraghavan Krishnamurthy, Abel Joseph, Shreyas Venkataraman, George Kurian
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Trends in the Performance of the Korean National Cancer Screening Program for Gastric Cancer from 2007 to 2016
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Luo-Wei Wang, Han Lin, Lei Xin, Wei Qian, Tian-Jiao Wang, Jian-Zhong Zhang, Qian-Qian Meng, Bo Tian, Xu-Dong Ma, Zhao-Shen Li
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Mickael Chevallay, Minoa Jung, Felix Berlth, Chon Seung-Hun, Philippe Morel, Stefan Mönig
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Quality Indicators and Outcome Measures of Endoscopy in the National Cancer Screening Program
Jun Ki Min, Jae Myung Cha, Min Seob Kwak, Jin Young Yoon, Yunho Jung, Jeong Eun Shin, Hyo-Joon Yang
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Journal of Clinical Gastroenterology.2018; 52(8): 703. CrossRef
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Bang Wool Eom, Kyu-Won Jung, Young-Joo Won, Hannah Yang, Young-Woo Kim
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Joon Sung Kim, Byung-Wook Kim
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Does the interval of screening endoscopy affect survival in gastric cancer patients?
Jieun Kim, Su Mi Kim, Man Ho Ha, Jeong Eun Seo, Min-Gew Choi, Jun Ho Lee, Tae Sung Sohn, Sung Kim, Sin-Ho Jung, Jae Moon Bae
Medicine.2016; 95(49): e5490. CrossRef

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Original Article

Feedback Survey of the Effect, Burden, and Cost of the National Endoscopic Quality Assessment Program during the Past 5 Years in Korea: Yu Kyung Cho, Jeong Seop Moon, Dong Su Han, Yong Chan Lee, Yeol Kim, Bo Young Park, Il-Kwun Chung, Jin-Oh Kim, Jong Pil Im, Jae Myung Cha, Hyun Gun Kim, Sang Kil Lee, Hang Lak Lee, Jae Young Jang, Eun Sun Kim, Yunho Jung, Chang Mo Moon, Ethics and Quality Control Committee of Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2016;49(6):542-547. Published online March 2, 2016; DOI: https://doi.org/10.5946/ce.2015.113

Abstract PDF PubReader ePub

Background
/Aims: In Korea, the nationwide gastric cancer screening program recommends biennial screening for individuals aged 40 years or older by way of either an upper gastrointestinal series or endoscopy. The national endoscopic quality assessment (QA) program began recommending endoscopy in medical institutions in 2009. We aimed to assess the effect, burden, and cost of the QA program from the viewpoint of medical institutions.
Methods
We surveyed the staff of institutional endoscopic units via e-mail.
Results
Staff members from 67 institutions replied. Most doctors were endoscopic specialists. They responded as to whether the QA program raised awareness for endoscopic quality (93%) or improved endoscopic practice (40%). The percentages of responders who reported improvements in the diagnosis of gastric cancer, the qualifications of endoscopists, the quality of facilities and equipment, endoscopic procedure, and endoscopic reprocessing were 69%, 60%, 66%, 82%, and 75%, respectively. Regarding reprocessing, many staff members reported that they had bought new automated endoscopic preprocessors (3%), used more disinfectants (34%), washed endoscopes longer (28%), reduced the number of endoscopies performed to adhere to reprocessing guidelines (9%), and created their own quality education programs (59%). Many responders said they felt that QA was associated with some degree of burden (48%), especially financial burden caused by purchasing new equipment. Reasonable quality standards (45%) and incentives (38%) were considered important to the success of the QA program.
Conclusions
Endoscopic quality has improved after 5 years of the mandatory endoscopic QA program.

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Medicine.2017; 96(19): e6742. CrossRef
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
Clinical Endoscopy.2017; 50(4): 345. CrossRef
How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program
Yu Kyung Cho
Clinical Endoscopy.2016; 49(4): 312. CrossRef
How Can We Propagate the National Endoscopy Quality Improvement Program and Improve the Quality of Endoscopic Screening?
Dong-Hoon Yang
Gut and Liver.2016; 10(5): 657. CrossRef
The Importance of an Endoscopic Quality Assessment Program Reflecting Real Practice
In Kyung Yoo, Yoon Tae Jeen
Clinical Endoscopy.2016; 49(6): 495. CrossRef

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Focused Review Series: Endoscopic Screening and Surveillance for Gastrointestinal Cancer

Prevention Strategies for Gastric Cancer: A Global Perspective: Jin Young Park, Lawrence von Karsa, Rolando Herrero; Clin Endosc 2014;47(6):478-489. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.478

Abstract PDF PubReader ePub

Despite the substantial burden of gastric cancer worldwide, population strategies for primary prevention have not been introduced in any country. Recognizing the causal role of Helicobacter pylori infection, there is increasing interest in population-based programs to eradicate the infection to prevent gastric cancer. Nonetheless, the paucity of available evidence on feasibility and effectiveness has prevented implementation of this approach. There are very few secondary prevention programs based on screening with endoscopy or radiography, notably in the Republic of Korea and Japan, two of the countries with the highest incidence rates of gastric cancer. In Korea, where the organized screening program is in place, survival rate of gastric cancer is as high as 67%. More research is needed to quantify the specific contribution of the screening program to observed declines in mortality rates. Gastric cancer screening is unlikely to be feasible in many Low-Middle Income Countries where the gastric cancer burden is high. Prevention strategies are still under development and the optimal approach may differ depending on local conditions and societal values. The present review gives an overview of the etiology and burden of the disease, and possible prevention strategies for countries and regions confronted with a significant burden of disease.

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Focused Review Series: Endoscopic and Molecular Imaging of Premalignant GI Lesions, Part II

Barrett Esophagus: When to Endoscope: Joshua Butt, Gabor Kandel; Clin Endosc 2014;47(1):40-46. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.40

Abstract PDF PubReader ePub

Increasing interest in identifying an effective strategy for decreasing the burden of esophageal adenocarcinoma (EAC) has been fuelled by the rising EAC rates worldwide, the morbidity associated with esophagectomy, and the development of endoscopic methods for curing early-stage EAC. In the face of this enthusiasm, however, we should be cautious about continuing our current evidence-free approach to screening and one with unclear benefits and unclear costs to the community. The literature is increasingly recognizing that the value of traditional endoscopy for screening and surveillance of Barrett esophagus may be more limited than initially believed. A better understanding of the risk factors for Barrett esophagus and progression to dysplasia and a more individualized risk calculation will be useful in defining populations to consider for Barrett screening. The development of novel, nonendoscopic screening techniques and of less expensive endoscopic techniques holds promise for a cost-effective screening and surveillance method to curtail the increasing rates of EAC.

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The importance of a second opinion in the diagnosis of Barretts esophagus: a real life study
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Diagnostic Accuracy of Mucosal Biopsy versus Endoscopic Mucosal Resection in Barrett’s Esophagus and Related Superficial Lesions
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Aneusomy detected by fluorescence in‐situ hybridization has high positive predictive value for Barrett's dysplasia
Euan A G Allan, Roy Miller, James J Going
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Veroushka Ballester, Marcia Cruz-Correa
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원저 : 식도 위장관 ; 건강검진 수진자 9,137 명에 대한 위내시경적 집단 검진 소견 ( Original Articles : Esophagus , Stomach & Intestine ; Esophgogastroduodenoscopic Findings in 9,137 Healthy Subjects Examined for the Secondary Prevention ): Korean J Gastrointest Endosc 1998;18(2):161-168. Published online November 30, 1997

Abstract PDF: Background
A esophagogastroduodenoscopy is now considered to be one of the essential rnethods for diagnosis of upper gastrointestinal disease. Furthermore early detection of stomach cancer by such a mass screening techique is very important to increase the survival rate. Methods: A clinical analysis was conducted on 9,137 healthy subjects who had undergone a gastrofiberscopic examination for the secondary prevention, from January 1995 to December 1996, in Kangbuk Samsung hospital. Results: 1) Number of cases with normal finding was 764 (8.4%). 2) The most prevalent disease found was chronic gastritis (82%). The number of cases with superficial gastritis was 64.7%, erosive gastritis 9.0%, atrophic gastritis 6.4% and metaplastic gastritis 1.6%. Atrophic and metaplastic gastritis were more frequent in the older age group. 3) The prevalence of peptic ulcer was 13.9% and duodenal ulcers (8.1%) was more common than gastric ulcers (5.8%, p<0.05) with a male to female ratio of 3.7: 1, and 2.1: 1 respectively. 4) Of the 10 cases with stomach cancer (0.11%), 5 cases (0.055%) were found to be advanced stomach cancer and the other 5 cases (0.055%) were early gastric cancer. The macroscopic type of early gastric cancer was type IIc in 4 cases and type IIb in another case, and 4 cases were limited in mucosa but another was in submucosa. The size of 4 cases were below 1 cm and there was no lymph node metastasis. Conclusion: Medically screened subjects were found to have many abnormalities, and therefore, it is recommanded that regular check ups using an endoscopy would be needed for early detection of early gastric cancer regardless of clinical symptoms. (Korean J Gastrointest Endosc 18: 161-168, 1998)

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자동차제조회사 근로자 1865명에 대한 위내시경적 집단검진 소견 ( Mass Screening for Stomach Cancer by Gastrofiberscopy in 1865 Employees of a Car Manufacturing Company ): Korean J Gastrointest Endosc 1993;13(2):347-352. Published online November 30, 1992

Abstract PDF: Background
Stomach cancer is the most commonly diagnosed malignant tumor in Korea. Early detection by mass screening very important to increase survival rate of stomach cancer, because the prognosis of early gastric cancer is excellent, and specific symptoms and physical findings are rare with early gastric cancer. Methed: 1865 car manufacturing company employees were examinined by gastrofiberscopy at a dispensary of the company from May 6, l992 to July 13, 1992. Results: 1. Number of cases with normal finding was 1262(67.7%), gastritis 422(22.6%), gastric ulcer 47(2.5%), gasrtric cancer 4(0.2%), duodenitis 39(2.1%), duodenal ulcer 63(3.4%), combined ulcer(gastric & duodenal) 2(0.1%,), post operative state 6(0.3%), and others 4(0.3%) in total 1865 examinees. 2. Of 422 cases with gastritis, cases with superficial gastritis were 171 (9.2%), atrophic gastritis 138(7.4%), erosive gastritis 94(5.0%) and hemorrhagic gastritis 19(1.0%). 3. Of 4 cases with stomach cancer, 1 case was advanced stomach cancer and 3 cases were early gastric cancer(two cases of IIc and one case of IIc+III) by macroscopic classification. Conclusion: Mass screening provides an excellent opportunity to detect gastric cancer in populations without symytoms or with nonspecific symptoms. It should be recommended to undergo screening exam for high risk group of stomach cancer.

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