Intest Res.  2019 Jan;17(1):119-126. 10.5217/ir.2018.00060.

The current capacity and quality of colonoscopy in Korea

• Choi JH
• Cha JM
• Yoon JY
• Kwak MS
• Jeon JW
• Shin HP

• KMID: 2438450
• DOI: http://doi.org/10.5217/ir.2018.00060

Abstract

BACKGROUND/AIMS
Little is known for the capacity and quality of colonoscopy, and adherence to colonoscopy surveillance guidelines in Korea. This study aimed to investigate the present and potential colonoscopic capacity, colonoscopic quality, and adherence to colonoscopy surveillance guidelines in Korea.
METHODS
We surveyed representative endoscopists of 72 endoscopy units from June to August 2015, using a 36-item questionnaire regarding colonoscopic capacity, quality, and adherence to colonoscopy surveillance guidelines of each hospitals.
RESULTS
Among the 62 respondents who answered the questionnaire, 51 respondents were analyzed after exclusion of 11 incomplete answers. Only 1 of 3 of endoscopy units can afford to perform additional colonoscopies in addition to current practice, and the potential maximum number of colonoscopies per week was only 42. The quality of colonoscopy was variable as reporting of quality indicators of colonoscopy were considerably variable (29.4%-94.1%) between endoscopy units. Furthermore, there are substantial gaps in the adherence to colonoscopy surveillance guidelines, as concordance rate for guideline recommendation was less than 50% in most scenarios.
CONCLUSIONS
The potential capacity and quality of colonoscopy in Korea was suboptimal. Considering suboptimal reporting of colonoscopic quality indicators and low adherence rate for colonoscopy surveillance guidelines, quality improvement of colonoscopy should be underlined in Korea.

Keyword

Colonoscopy; Colorectal neoplasms; Quality; Surveys and questionnaires; Guideline

MeSH Terms

Colonoscopy*
Colorectal Neoplasms
Endoscopy
Korea*
Quality Improvement
Surveys and Questionnaires

Reference

1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015; 65:87–108.

2. Jung KW, Park S, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality and survival in 2006-2007. J Korean Med Sci. 2010; 25:1113–1121.

3. Burt RW. Colorectal cancer screening. Curr Opin Gastroenterol. 2010; 26:466–470.

4. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy: the National Polyp Study Workgroup. N Engl J Med. 1993; 329:1977–1981.

5. Vleugels JL, van Lanschot MC, Dekker E. Colorectal cancer screening by colonoscopy: putting it into perspective. Dig Endosc. 2016; 28:250–259.

6. Rex DK, Lieberman DA. Feasibility of colonoscopy screening: discussion of issues and recommendations regarding implementation. Gastrointest Endosc. 2001; 54:662–667.

7. Levin TR. Colonoscopy capacity: can we build it? Will they come? Gastroenterology. 2004; 127:1841–1844.

8. Brown ML, Klabunde CN, Mysliwiec P. Current capacity for endoscopic colorectal cancer screening in the United States: data from the National Cancer Institute Survey of Colorectal Cancer Screening Practices. Am J Med. 2003; 115:129–133.

9. Mysliwiec PA, Brown ML, Klabunde CN, Ransohoff DF. Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy. Ann Intern Med. 2004; 141:264–271.

10. Pickard M, Dewar EP, Kapadia RC, Khan RB, Hutchinson IF, Nejim A. Follow up of patients with colorectal polyps: are the BSG guidelines being adhered to? Colorectal Dis. 2007; 9:203–206.

11. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012; 143:844–857.

12. Yang DH, Hong SN, Kim YH, et al. Korean guidelines for postpolypectomy colonoscopy surveillance. Clin Endosc. 2012; 45:44–61.

13. Lucendo AJ, González-Huix F, Tenias JM, et al. Gastrointestinal endoscopy sedation and monitoring practices in Spain: a nationwide survey in the year 2014. Endoscopy. 2015; 47:383–390.

14. Repici A, Pagano N, Hassan C, et al. Balanced propofol sedation administered by nonanesthesiologists: the first Italian experience. World J Gastroenterol. 2011; 17:3818–3823.

15. Riphaus A, Geist F, Wehrmann T. Endoscopic sedation and monitoring practice in Germany: re-evaluation from the first nationwide survey 3 years after the implementation of an evidence and consent based national guideline. Z Gastroenterol. 2013; 51:1082–1088.

16. Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013; 19:463–481.

17. Seeff LC, Manninen DL, Dong FB, et al. Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States? Gastroenterology. 2004; 127:1661–1669.

18. Seeff LC, Richards TB, Shapiro JA, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC’s survey of endoscopic capacity. Gastroenterology. 2004; 127:1670–1677.

19. Mehrotra A, Dellon ES, Schoen RE, et al. Applying a natural language processing tool to electronic health records to assess performance on colonoscopy quality measures. Gastrointest Endosc. 2012; 75:1233–1239. e14.

20. de Jonge V, Sint Nicolaas J, Cahen DL, et al. Quality evaluation of colonoscopy reporting and colonoscopy performance in daily clinical practice. Gastrointest Endosc. 2012; 75:98–106.

21. Sohn DK; Colonoscopy Study Group of the Korean Society of Coloproctology. A survey of colonoscopic surveillance after polypectomy. Ann Coloproctol. 2014; 30:88–92.

22. Kang MS, Park DI, Park JH, et al. A survey on the interval of post polypectomy surveillance colonoscopy. Korean J Gastrointest Endosc. 2006; 33:339–345.

23. Patel N, Tong L, Ahn C, Singal AG, Gupta S. Post-polypectomy guideline adherence: importance of belief in guidelines, not guideline knowledge or fear of missed cancer. Dig Dis Sci. 2015; 60:2937–2945.

24. Hong SN, Yang DH, Kim YH, et al. A survey of post-polypectomy surveillance. Intest Res. 2011; 9:118–128.

25. Tanaka S, Obata D, Chinzei R, et al. Surveillance after colorectal polypectomy; comparison between Japan and U.S. Kobe J Med Sci. 2011; 56:E204–E213.

26. Boolchand V, Olds G, Singh J, Singh P, Chak A, Cooper GS. Colorectal screening after polypectomy: a national survey study of primary care physicians. Ann Intern Med. 2006; 145:654–659.

27. Saini SD, Kim HM, Schoenfeld P. Incidence of advanced adenomas at surveillance colonoscopy in patients with a personal history of colon adenomas: a meta-analysis and systematic review. Gastrointest Endosc. 2006; 64:614–626.

28. Ellett ML. A literature review of the safety and efficacy of using propofol for sedation in endoscopy. Gastroenterol Nurs. 2010; 33:111–117.