How Can We Propagate the National Endoscopy Quality Improvement Program and Improve the Quality of Endoscopic Screening?

The National Cancer Screening Program (NCSP) has been provided since 1999 in Korea and the annual surveys for National Cancer Screening showed gradual increase in both the lifetime screening rates and screening rates with recommendation of gastric and colorectal cancers. 1 In addition to the nationwide propagation of the screening program, the improvement in the endoscopic quality is critical to reduce the mortality related to gastric and colorectal cancers and to minimize the probability of endoscopy-related complications. The National Endoscopy Quality Improvement Program (NEQIP) has been developed to improve the quality of endoscopic screening program of the NCSP. 2 NEQIP includes various factors related to quality of instruments in the endoscopy units, endoscopic procedures, endoscopic sedation, endoscopic reprocessing, and screening outcomes, as well as qualification of endoscopists. 2 In the original paper of Gut and Liver, titled as " National en-doscopy quality improvement program remains suboptimal in Korea, " Cha et al. 3 reported the results of survey to investigate the nationwide data about the endoscopic capacity, endoscopic sedation, and reprocessing of the endoscopes. A total of 547 physicians, including 342 gastroenterologists, responded in this web-based survey. Although the total response rate was low (18.8%), this survey provides some important insights related to nationwide screening endoscopy. 3 First, given that the typical waiting time for screening esophagogastroduodenoscopy and colonoscopy was less than 4 weeks in more than 90%, 3 the endoscopic capacity of NCSP can be considered appropriate relative to the current endoscopic screening rates. However, as the screening rate with recommendations has increased gradually since 2004, 1 the current endoscopic capacity may not be sufficient for the increased endoscopic demand in near future. As expected, according to the current survey, the insufficient financial reimbursement is considered as a major obstacle to accommodate the endoscopic demand in their clinical practice. 3 The survey results also showed that the performance and understanding in endoscopy reprocessing are still suboptimal in spite of the application of quality improvement program since 2009. 3 As the authors suggested, understanding of NEQIP and knowledge about the reprocessing are necessary to improve the performance of endoscopy reprocessing. However, the results of this survey did not assess the burden and cost of the individual endoscopists or endoscopy units that would require to improve the endoscopy reprocessing. According to another survey about the burden and cost related to the NEQIP, 4 52% of the respond-ers answered that they were …