Endoscopist Specialty Is Associated with High-Quality Endoscopy in Korea

차재명,한동수,이항락,김영호,정일권,김현수,문정섭,조유경 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.2

Purpose: The present study was aimed to determine whether endoscopist specialty is associated with high-quality endoscopy. Materials and Methods: We prospectively collected endoscopy quality related data based on the Endoscopy Quality Rating Scale (EQRS) of 277 endoscopy units in a hospital setting from the National Cancer Screening Program of Korea in 2009. Gastroenterology medical professors (n=154) from university hospitals visited each endoscopy unit and graded the unit according to the EQRS. The scores from the EQRS were analyzed and compared in relation to endoscopy training during residency and endoscopy subspecialist certification. Results: After excluding data from 3 endoscopy units, EQRS data from 274 endoscopy units were analyzed: 263 esophagogastroduodenoscopy (EGD) screening units and 90 colonoscopy screening units. There were no significant differences in the scores of EQRS with respect to endoscopy training during residency (p=no significance), except for scores of EGDs for “Facility and Equipment”(p=0.030). However, EQRS scores were significantly higher in the endoscopy units where endoscopy subspecialists performed the endoscopies than those where Endoscopy Subspecialists did not perform the endoscopies (p<0.05, except p=0.08 for the “Process” criteria of EGD). Conclusion: Endoscopist specialty is an important determinant of high-quality endoscopy in Korea.

상부 위장관 내시경 검사 시 보호자 참여가 환자의 동통 및 불편감에 미치는 영향

유종윤,함상근,전정윤,이상혁,조성환,박진아 대한가정의학회 2008 Korean Journal of Family Medicine Vol.29 No.1

연구배경: 상부 위장관 내시경 검사는 위십이지장 질환의 진단에 필수적이지만 검사 시 환자가 느끼는 불편감으로 인하여 검사를 회피하거나 진단이 늦어지기도 한다. 이에 본 연구는 상부 위장관 검사 시의 동통 및 불편감과 연관된 요인과 내시경 검사 시 활력 징후의 변화를 살펴보고, 보호자를 내시경 검사에 참여하도록 하여 내시경을 시행한 경우 환자의 동통 및 불편감을 줄일 수 있는지 알아보고자 하였다. 방법: 2005년 7월에서 8월까지 서울 소재 일개 종합병원의 건강검진센터에서 보호자를 동반하여 상부 위장관 내시경 검사를 받은 환자 147명을 두 군으로 나누어, 한 군은 보호자를 내시경 검사에 참여하여 내시경검사 중 환자를 격려하도록 하였고, 다른 군은 환자 혼자서 내시경 검사를 받도록 하여, 두 군 사이의 내시경 검사 시 느끼는 동통에 차이가 있는지 평가하였다. 동통 또는 불편감에 대한 지표로 시각적 상사척도를 사용하여 자기기입식 설문지 방법을 통하여 조사하였다. 또한 연구에 참여한 대상자의 인구학적 특성을 살펴보고, 내시경 검사 중에 느끼는 동통과의 연관성 및 활력 징후를 살펴보았다. 결과: 보호자가 내시경 검사에 참여한 군(n=70)의 시각적 상사척도의 점수가 3.51±1.90점으로 보호자가 참여하지 않은 군(n=77)의 4.35±2.10점보다 통계학적으로 유의하게 낮게 측정되었다(P=0.012). 내시경 후 산소 포화도는 보호자 참여군에서 낮았지만, 통계적으로 유의하지 않았다(P=0.48). 또한 인구학적 특성 및 내시경 검사와 관련된 다른 요인들을 포함하여 다중회귀분석을 시행한 후에도, 보호자 참여 여부는 내시경 검사 시의 동통에 영향을 미치는 유의한 요인이었다(P=0.027). 결론: 내시경 검사 시에 느끼는 동통은 환자의 특성 및 내시경과 관련된 요인과는 관련이 없었다. 반면 내시경 검사 시 보호자를 참여하도록 하여 환자의 심리적 상태를 안정시킬 경우 동통 및 불편감이 적은 것으로 보아 내시경 검사 시 심리적 안정상태가 중요하며 내시경 시행의가 느끼는 부담감이 적다면 보호자를 내시경 검사에 같이 참여하도록 하는 것이 도움이 될 수 있다. ackground: Upper gastrointestinal endoscopy is a very important and highly sensitive method to detect gastroduodenal lesions. But the investigation and diagnosis of gastrointestinal diseases might be delayed by discomfort, pain and anxiety in patients during endoscopy. This study was performed to evaluate the effect of family member’s attendance on relief of discomfort in patients and to identify the predictors for pain and discomfort during upper gastrointestinal endoscopy. Methods: From July to August 2005, 147 clients who underwent gastrointestinal endoscopy were enrolled in this study. The subjects were randomly grouped into family-attended (n=70) group and non-family-attended group (n=77). The patients recorded their pain and discomfort during endoscopy by Visual-Analogue Scale (VAS) score. And also the client's demographic characteristics and endoscopy related factors (procedure duration, previous endoscopy experience, biopsy, endoscopist etc.) were evaluated. We studied the relationship between the various characteristics and discomfort during endoscopy. Results: There were no significant differences of clients’ demographic characteristics and endoscopy related factors between the two groups. There was a significant difference of VAS scores between the family-attended group (3.51±1.90) and non-family-attended group (4.35±2.10) (P= 0.012). Oxygen saturation and pulse rate during the procedure were lower in the family-attended group than in the non-attended group. Recipients' demographic characteristics and various factors related with the procedure (waiting time, biopsy, and previous experience, etc) were not associated with the degree of discomfort. Conclusion: Family member’s attendance decreased pain and discomfort during endoscopy. The recipients' demographic characteristics and factors related to the procedure had no influence on the degree of discomfort during endoscopy. In conclusion, attendance of a family member should be considered during endoscopy in order to decrease pain and discomfort during the procedure. (J Korean Acad Fam Med 2008;29:13-19)

Highlights of International Digestive Endoscopy Network 2013

권광안,최일주,김은영,동석호,함기백 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.5

Rapid advances in the technology of gastrointestinal endoscopy as well as the evolution of science have made it necessary for us to continue update in either various endoscopic techniques or state of art lectures relevant to endoscopy. International Digestive Endoscopy Network (IDEN) 2013 was held in conjunction with Korea-Japan Joint Symposium on Gastrointestinal Endoscopy (KJSGE) during June 8 to 9, 2013 at Seoul, Korea. Two days of impressive scientific program dealt with a wide variety of basic concerns from upper gastrointestine (GI), lower GI, pancreaticobiliary endoscopy to advanced knowledge including endoscopic submucosal dissection forum. IDEN seems to be an excellent opportunity to exchange advanced information of the latest issues on endoscopy with experts from around the world. In this special issue of Clinical Endoscopy, we prepared state of art review articles from contributing authors and the current highlights will skillfully deal with very hot spots of each KJSGE, upper GI, lower GI, and pancreaticobiliary sessions by associated editors of Clinical Endoscopy.

Comparison of the Effectiveness of Interventional Endoscopy in Bleeding Peptic Ulcer Disease according to the Timing of Endoscopy

( Hyun Seok Cho ),( Dong Soo Han ),( Sang Bong Ahn ),( Tae Jun Byun ),( Tae Yeob Kim ),( Chang Soo Eun ),( Yong Cheol Jeon ),( Joo Hyun Sohn ) 대한소화기기능성질환·운동학회 2009 Gut and Liver Vol.3 No.4

Background/Aims: The optimal timing for interventional endoscopy in bleeding peptic ulcer disease is controversial. This study compared the outcomes between early endoscopy and delayed endoscopy in patients with bleeding peptic ulcer disease. Methods: We conducted a prospective analysis of data from 90 patients with bleeding peptic ulcer disease who visited the emergency room between May 2006 and September 2007. Patients were categorized into two groups: the early-endoscopy group (admitted during the daytime or at night with prompt endoscopic management) and the delayed-endoscopy group (admitted at night or during weekends, with endoscopic management delayed until the next day). We compared the clinical outcomes of endoscopy between the two groups. Results: There were 49 patients in the early-endoscopy group and 41 patients in the delayed-endoscopy group. Patient demographics, clinical characteristics, bleeding control modality, and Rockall score did not differ between the two groups. There were also no significant differences between the early- and delayed-endoscopy groups in the re-bleeding rate (3/49 vs 5/41, p=0.313), the duration of hospital stay (10.7 vs 9.3 days, p=0.437), and the total amount of blood transfused (3.4 vs 2.7 units, p=0.240). Conclusions: The effectiveness of interventional endoscopy for patients with bleeding peptic ulcer disease is not significantly affected by the timing of endoscopy. (Gut and Liver 2009;3:266-270)

Does Early Endoscopy Affect the Clinical Outcomes of Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding? A Systematic Review and Meta-Analysis

Bai Liyi,Jiang Wei,Cheng Rui,Dang Yan,Min Li,Zhang Shutian 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.4

Background/Aims: In patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB), the optimal timing of endoscopy is still a matter of dispute. We conducted a systematic review and meta-analysis to determine the clinical benefit of early endoscopy. Methods: A literature search of the MEDLINE, Embase, and Cochrane databases was conducted to identify publications from inception to March 1, 2022. Eligible studies included observational cohort studies and randomized controlled trials that reported clinical outcomes of endoscopy in patients with ANVUGIB. ANVUGIB patients who underwent endoscopy within 24 hours of admission were considered to have had an early endoscopy. The primary outcome was the mortality rate in ANVUGIB patients who had early or nonearly endoscopy. Results: The final analysis included five randomized controlled studies (RCTs) and 20 observational studies from the 1,206 identified articles. The mortality rate was not significantly reduced among patients who received endoscopy performed within 24 hours, whether in cohort studies nor in RCTs. For subgroup analysis, a higher mortality rate was found only among patients who received very early endoscopy within 12 hours (odds ratio, 1.66; p<0.001, I2=0) in cohort studies. No significant difference in mortality rates was found among patients at high risk of bleeding who received early versus nonearly endoscopy. Conclusions: Early endoscopy within 24 hours does not appear to significantly reduce the mortality rates of patients with ANVUGIB. Further well-designed studies are warranted to address if very early endoscopy within 12 hours can provide a clinical benefit for patients at high risk of bleeding.

Sketch of International Digestive Endoscopy Network 2012 Meeting: Overview

Ho Gak Kim 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.3

International Digestive Endoscopy Network (IDEN) is an international meeting covering scientific subjects of diverse topics about upper gastrointestinal (GI) endoscopy, colonoscopy, endoscopic ultrasonography, and PB endoscopy. IDEN is organized by Korean Society of Gastrointestinal Endoscopy and the Korean Gastrointestinal Endoscopy Research Foundation, and took its first step in 2011 in Seoul, Korea. IDEN inaugurated a new era of diagnostic and therapeutic GI endoscopy. IDEN 2012 was designed to offer participants from all over the world with opportunities to share up-to-date knowledge about basic and clinical aspects of GI endoscopy and to engage in in-depth discussion with worldwide well-known experts. During the 2 days of meeting, there were 62 invited lectures, 28 case-based discussions, 20 video lectures, and 6 breakfast with the experts. There were a total of 598 participants registered from 12 countries, including Asian countries, Europe, and USA as well as Korea.

LC : Safety of Sleep Endoscopy for Secondary Prophylactic Endoscopic Band Ligation in Patients with Liver Cirrhosis who had a Previous History of Variceal Bleeding

( Hyun Jung Lee ),( Young Joo Jin ),( Jin Woo Lee ),( Hyun Jung Chung ),( Byung Wook Bang ),( Seok Jeong ),( Kye Sook Kwon ),( Don Haeng Lee ),( Hyung Gil Kim ),( Yong Woon Shin ),( Young Soo Kim ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: Patients with liver cirrhosis frequently undergo secondary prophylactic endoscopic band ligation (EVL), and these patients can suffer from EVL with non-sleep endoscopy. Given the impaired metabolism of drugs administered for sedation in cirrhotic patients, we investigated the safety of sleep endoscopy for secondary prophylactic EVL in those patients who had a previous history of variceal bleeding Methods: A total of 59 cases with secondary prophylactic EVL that were performed at our institution between August, 2010 and April, 2013 were consecutively recruited. We compared the frequency of hepatic encephalopathy (HEP) between patients with sleep endoscopy and non-sleep endoscopy. Midazolam was intravenously injected for conscious sedation, and flumazenil was always used as antidote after sleep endoscopy. Results: The median patient`s age was 55 years (range, 29-89 years). The most common causes of liver cirrhosis were hepatitis B virus infection (44.1%) and alcohol (42.4%). Of the 59 cases, 39 (66.1%), 13 (22.0%), and 7 (11.9%) had Child-Tur- Turcotte- Pugh class A, B, and C, respectively. Sleep endoscopy was performed in 52 (88.1%) of the 59 cases [CTP class A (n=35, 67.3%), B (n=13, 25.0%), and C (n=4, 7.7%), respectively], and the remaining 7 (11.9%) underwent non-sleep endoscopy. Median dosage of midazolam was 5 mg (range, 2-10 mg). None of the patients had experienced HEP after sleep endoscopy for secondary prophylactic EVL, and this result was same to those with non-sleep endoscopy. Conclusions: Our data showed that intravenous midazolam may be used safely in cirrhotic patients, even in those with CTP class C undergoing secondary prophylactic EVL for conscious sedation, but large scaled prospective randomized studies should be performed to confirm our results.

Risk Factors for Prolonged Hospital Stay after Endoscopy

Toshihiro Nishizawa,Shuntaro Yoshida,Osamu Toyoshima,Tatsuya Matsuno,Masataka Irokawa,Toru Arano,Hirotoshi Ebinuma,Hidekazu Suzuki,Takanori Kanai,Kazuhiko Koike 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6

Background/Aims: The recovery room used after endoscopy has limited capacity, and an efficient flow of the endoscopy unitis desired. We investigated the duration of hospital stay after endoscopy and the risk factors for prolonged hospital stay amongoutpatients. Methods: We retrospectively studied consecutive patients who underwent esophagogastroduodenoscopy or colonoscopy at theToyoshima Endoscopy Clinic. We collected data on age, sex, body weight, midazolam and pethidine dosage, respiratory depressionduring endoscopy, and duration of hospital stay after endoscopy (scope out to check out). Risk factors for prolonged hospital stay (>100minutes) were identified using multiple logistic regression analysis. Results: We enrolled 3,898 patients, including 3,517 (90.2%) patients tested under sedation and 381 (9.8%) patients tested withoutsedation. Overall, 442 (11.3%) patients had prolonged stay (>100 min). The mean time difference between sedation group and nonsedationgroup was 44.2 minutes for esophagogastroduodenoscopy and 39.1 minutes for colonoscopy. Age (odds ratio [OR], 1.025;95% confidence interval [CI], 1.014−1.036), female sex (OR, 1.657; 95% CI, 1.220−2.249), and midazolam dose (OR, 1.019; 95% CI,1.013−1.026) were independently associated with prolonged hospital stay after esophagogastroduodenoscopy, with similar results forcolonoscopy. Conclusions: Old age, female sex, and midazolam dose were independent risk factors for prolonged hospital stay after endoscopy.

국내 내시경 질 향상의 과거, 현재, 미래

차재명 ( Jae Myung Cha ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.6

The motivation for improving quality of gastrointestinal endoscopy begins with the desire to provide patients with the best possible care. Gastrointestinal endoscopy is an excellent area for quality improvement because of its high volume, significant associated risk and expense, and variability in its performance affecting outcomes. Therefore, the assurance that high-quality endoscopic procedures are performed has taken increased importance. The ‘Korean Gastrointestinal Endoscopy Research Foundation’ and ‘Korean Society of Gastrointestinal Endoscopy’, as ladders in promoting the highest quality patient care, formed endoscopy quality evaluation in ‘National Cancer Screening Program’ and ‘Endoscopy Unit Accreditation’ in Korea. However, both new systems have not settled down despite efforts of many years and support by the government. In this article, the past and present of quality improvement of gastrointestinal endoscopy will be reviewed, and the future of quality improvement of gastrointestinal endoscopy will be illuminated. (Korean J Gastroenterol 2014;64:320-332)

Submucosal endoscopy: the present and future

Zaheer Nabi,Duvvur Nageshwar Reddy 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.1

Submucosal endoscopy or third-space endoscopy utilizes the potential space between the mucosal and muscularis layers of the gastrointestinaltract to execute therapeutic interventions for various diseases. Over the last decade, endoscopic access to the submucosalspace has revolutionized the field of therapeutic endoscopy. Submucosal endoscopy was originally used to perform endoscopic myotomyin patients with achalasia cardia, and its use has grown exponentially since. Currently, submucosal endoscopy is widely used to resectsubepithelial tumors and to manage refractory gastroparesis and Zenker’s diverticulum. While the utility of submucosal endoscopyhas stood the test of time in esophageal motility disorders and subepithelial tumors, its durability remains to be established in conditionssuch as Zenker’s diverticulum and refractory gastroparesis. Other emerging indications for submucosal endoscopy include esophagealepiphrenic diverticulum, Hirschsprung’s disease, and esophageal strictures not amenable to conventional endoscopic treatment. The potential of submucosal endoscopy to provide easy and safe access to the mediastinum and peritoneal spaces may open doors tonovel indications and rejuvenate the interest of endoscopists in natural orifice transluminal endoscopic surgery in the future. This reviewfocuses on the current spectrum, recent updates, and future direction of submucosal endoscopy in the gastrointestinal tract.