상부위장관 내시경의 질관리: 내시경 시행 중심으로
Quality Control for Upper Gastrointestinal Endoscopy
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초록
상부위장관 내시경은 소화기 임상에서 가장 많이 사용되는 검사법이다. 특히 한국과 같이 위암이 흔한 나라에서는 높은 수준의 내시경이 요구된다. 내시경 질관리에 대한 내용은 매우 광범위하므로 이 중 내시경 수행 과정에서 중요한 부분을 정리하고자 하였다. 내시경 수행 중 질 관리는 크게, 내시경 시술 전, 시술 중, 및 시술 후로 나눌 수 있다. 내시경 시술 전에는 내시경 검사가 적절한지, 환자의 동의서, 환자의 임상 상태 및 위험도 평가, 위험도를 줄이기 위한 처치(예를 들어, 예방적 항생제 투여, 항응고제 처치 등) 등을 관리하여야 한다. 내시경 시술 중의 질 관리는 최소한 환자 모니터링, 약물 투여, 회복에 대한 노력, 중요한 병변을 촬영한 내시경 사진 등이 기본이 되어야 한다. 시술 후에는 내시경 결과보고서, 검사 후 회복관리, 검사 후 주의사항 안내, 병리검사 추적 계획 등이 필요하다. 내시경 질 평가를 정기적으로 모니터링 하는 것은 더 높은 수준의 내시경을 수행하는데 필수불가결한 부분이다. 내시경 의사가 근무하는 환경에 따라 가장 적절한 내시경 질을 측정하는 판단 기준을 정립하여 수행하는 것이 필요할 것이다.
Abstract
Upper gastrointestinal endoscopy is the most common procedure in the field of gastroenterology. Controlling the quality of endoscopy is quite important because gastric cancer is the most prevalent cancer in Korea. For each endoscopic procedure, the indicators of quality control can be considered for 3 time periods: the preprocedure, intraprocedure and postprocedure periods. The common issues during preprocedure include the proper indications, the patient’s consent for the procedure, the patient’s clinical status and the risk assessment, and the steps to reduce the risk. The common issues during intraprocedure include all the technical aspects of the procedure, including completion of the examination and any of the therapeutic maneuvers. The postprocedure activities include providing instructions to the patient, documentation of the procedure, recognition and documentation of complications, follow-up of the pathologic conditions and assessing the patient’s satisfaction. Regular monitoring the quality of endoscopy can raise the level of performing endoscopic procedures.
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