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A Survey of Colonoscopic Surveillance After Polypectomy
손대경,Colonoscopy Study Group of the Korean Society of Coloproctology 대한대장항문학회 2014 Annals of Coloproctolgy Vol.30 No.2
Purpose: Several guidelines have been proposed for surveillance colonoscopy after polypectomy. However, some discrepancies still exist between the guidelines and clinical practice. This study was conducted to identify Korean doctors’ recommendations for the colonoscopic surveillance interval after polypectomy. Methods: A survey of the attendees at the symposium of the 64th Annual Congress of the Korean Surgical Society was conducted. When the prepared clinical scenarios were given, attendees answered using a wireless radio-frequency audience response system. All responders’ results were automatically counted immediately. Frequencies of different answers to each question were calculated, and our results were compared with those of previous surveys performed using the same questionnaire in the United States or Japan. Results: The number of responder varied from 38 to 41. About 50% of valid responders selected ‘follow-up in 3 years’ for low-risk lesions, such as a 6-mm hyperplastic polyp, a 6-mm tubular adenoma, or two 6-mm tubular adenomas. Responders most-commonly selected ‘follow-up in 1 year’ for high-risk lesions, such as a 12-mm tubular adenoma with high grade dysplasia or a 12-mm tubulovillous adenoma. The majority of Korean doctors recommend postpolypectomy colonoscopic surveillance more frequently than American physicians did. Conclusion: A discrepancy between the guidelines and clinical practice for the surveillance after polypectomy still exists in Korea. A surveillance program that can be easily and widely applied in clinical practice needs to be established.
DISCERN 평가도구를 이용한 대장암 정보 제공 웹 사이트의 질 평가
손대경,최효성,이동욱,이상전,이진석,이영성 대한대장항문학회 2005 Annals of Coloproctolgy Vol.21 No.4
Purpose: Many patients rely on the Internet for medical information. In Korea, there are many websites providing medical information, but the quality of these websites relating to colorectal cancer remains to be clarified. This study was performed to evaluate the quality of websites providing information on colorectal cancer. Methods: Firstly, sites were identified using four major domestic search engines and were classified according to the administrator. Then, two surgical oncologists used the ‘DISCERN’ instrument to assess 12 sites (including 2 foreign sites) for the reliability and the quality of the information on treatment choice. Results: Total 297 sites were identified using the search term ‘colorectal cancer’. Excluding dead links or duplicated sites, 148 sites were identified. When the sites had been classified according to the administrator of the websites, 115 (77.7%) were identified as local clinic or hospital sites, 8 (5.4%) as medical school sites, 7 (4.7%) as institute or public health sites, 11 (7.4%) as commercial sites, and 7 (4.7%) as private sites. The results of the evaluations by the two examiners showed moderate inter-examiner reliability (K=0.41). The evaluations of the domestic sites by using DISCERN showed serious or important shortcomings in the quality of information on treatment choices and in reliability. Among these domestic websites, the quality of information provided at private or local hospital sites was poorer than that provided at institute or public health sites. Conclusions: About 80% of the websites providing medical information on colorectal cancer were identified as private or local hospital sites. Evaluations of the information provided at domestic sites showed serious or important shortcomings.
손대경,김민주,박윤희,서민아,신애선,이희영,임종필,조현민,홍성필,김백희,김용수,김정욱,김현수,남정모,박동일,엄준원,오순남,임환섭,장희진,함상근,정지혜,김수영,김열,이원철,정승용 대한의사협회 2015 대한의사협회지 Vol.58 No.5
Colorectal cancer is the third most common cancer in Korea; it is the second most common cancer in men and the third most common in women. The incidence rate in Korea has continuously increased since 1999 when the National Cancer Registry statistics began. Currently; there are several screening modalities; that have been recommended by expert societies, including fecal occult blood test, colonoscopy, computed tomographic colonography The annual fecal immunochemical test (FIT) has been used in adults aged 50 and older as part of the National Cancer Screening Program in Korea since 2004. Although several study results from regional or national colorectal cancer screening programs in other countries have been reported, the National Cancer Screening Program in Korea has not yet been evaluated with evidence-based methods. Herein report the consensus statements on the National Screening Guideline for colorectal cancer developed by a multi-society expert committee in Korea, as follows: 1) We recommend annual or biennial FIT for screening for colorectal cancer in asymptomatic adults, beginning at 45 years of age and continuing until 80 years (recommendation B). 2) There is no evidence for the risks or benefits of FIT in adults older than 80 years (recommendation I). 3) Selective use of colonoscopy for colorectal cancer screening is recommended, taking into consideration individual preference and the risk of colorectal cancer (recommendation C). 4) There is no evidence for the risks or benefits of double-contrast barium enema for colorectal cancer screening in asymptomatic adults (recommendation I). 5) There is no evidence for the risks or benefits of computed tomographic colonography for colorectal cancer screening in asymptomatic adults (recommendation I).
손대경 대한내시경복강경외과학회 2016 Journal of Minimally Invasive Surgery Vol.19 No.2
Natural orifice transluminal endoscopic surgery (NOTES) is the integration of laparoscopic minimally invasive surgery techniques with flexible endoscopy technology. Surgical treatment has been in constant evolution in the search for minimizing incisions, regardless of the complexity of the operation. NOTES represents another step in this ongoing progression toward less invasive procedures. The advantages of such an approach includes reduced incisional pain, decreased wound complications, such as infections and hernias, improved cosmetic results, and potentially faster recovery and return to work. Until substantial improvement in NOTES instrumentation is made to optimize this approach, these procedures are likely to require laparoscopic assistance. Critics challenge the safety and advantages of this technique in the face of effective minimally invasive surgical options such as laparoscopic surgery. Here, we hope to discuss about the current NOTES status and techniques.