The Korean Society of Gastrointestinal Endoscopy (KSGE) introduced the Accredited Endoscopy Unit Program to enhance the quality of endoscopy units through systematic quality management. Accredited endoscopy units are certified by KSGE to perform high-quality endoscopy practices. The important factors required to deliver the best endoscopy practice are as follows:

(1) Credentialing of endoscopy staff.

(2) Are the institutions following the guidelines for safety, endoscope disinfection, and endoscopic sedation as their unit policies as recommended by the KSGE?

(3) Do the endoscopy staff follow the standardized endoscopy procedures and assess their performance to meet the performance criteria?

(4) Continuous quality improvement activities

The system was introduced in 2012 at the level of an endoscopy specialist training hospital but was gradually expanded to institutions with having more than one hundred in-patient beds in 2014. It has now certified endoscopy units in more than 200 institutions, including more than 80 training hospitals. The criteria for certification must be revised on the basis of the actual conditions of each institution. On the basis of continuous communication with the site and feedback, the criteria for assessment of certification of the accredited endoscopy unit were revised in 2019 and will be introduced.

The six evaluation areas of the accredited endoscopy unit program are as follows:

(1) Qualification of endoscopists

(2) Facilities and equipment

(3) Process

(4) Performance

(5) Disinfection and infection control

(6) Endoscopic sedation

The assessment items are composed of mandatory and recommended items (Table 1). All mandatory items must be met for accreditation to be awarded. The program must be recertified every 3 years after the initial certification.

Rationale: Upper gastrointestinal (GI) endoscopy and colonoscopy must be performed by licensed physicians to ensure diagnostic accuracy and patient safety. It is necessary to set appropriate qualification standards for physicians who perform upper GI endoscopy. Supportive data on the appropriate endoscopy treatment experience to gain competency or qualification are inadequate (Table 3). We can say that qualified endoscopy can be implemented only by an endoscopist who has a certain amount of experience at a training hospital with a qualified education supervisor. The KSGE recommends the performance of over 1,000 cases of upper GI endoscopy under the guidance of an instructor during the training period as a prerequisite for endoscopy specialist board certification by KSGE [1]. The recommendations of the Japanese Society of Gastrointestinal Endoscopy [2] and American Society of Gastrointestinal Endoscopy [3] for ensuring competency are different from those of the KSGE. According to the quality guidelines for the national gastric cancer screening program in Korea, an endoscopy experience of at least 500 cases is strongly recommended for participation in the national gastric cancer screening program [4].

Colonoscopy is an invasive procedure that can lead to complications, and differences in intubation success and diagnostic rates may result from practitioner competency [5]. Some studies have reported differences in the detection rate of colorectal adenoma among practitioners and that the risk of overlooking colorectal cancer may vary depending on course content or majors of the training curriculum the practitioners completed [6,7]. KSGE recommends the performance of over 150 cases of colonoscopy under the guidance of an instructor during the training period as a prerequisite for colonoscopists [1]. To participate in the national colon cancer screening program, physicians should perform more than 150 colonoscopies in supervised training sessions for 1 year [8]. If a physician has not received endoscopy training, an experience of performing a minimum of 300 successful colonoscopies is required to conduct a national colon cancer screening [8]. In contrast, the Accredited Endoscopy Unit Program requires most physicians to undergo training for more than 1 year with a supervisor and endoscopy specialist board certified by the KSGE.

Rationale: From various studies conducted in Korea, it is well known that endoscopic examination proficiency and completion rate are correlated with endoscopist experience. Although the actual number of procedures performed does not necessary prove the endoscopist’s skills, a minimum number of performed procedures is required for the assessment of proficiency and other performance indicators. The European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis recommends that endoscopists participating in colorectal cancer screening programs should have experience performing at least 300 cases of colonoscopy per year [9], while the British Quality Assurance Guidelines for Colonoscopy requires that at least 100 procedures be performed each year to maintain colonoscopy proficiency [10]. These represent minimum requirements for assessing endoscopist proficiency, and these guidelines recommend that the number of endoscopic procedures performed per year by each endoscopist be recorded. The standards for the number of endoscopy procedures performed per year recommended in various guidelines have a low quality of evidence and were proposed based on expert opinions. Accordingly, the standards being applied in Korea are also based on expert opinions, with the Quality Management Committee of the KSGE recommending 200 cases of upper GI endoscopy and 100 cases of colonoscopy per year.

Rationale: Endoscopy nursing personnel should have professional endoscopy knowledge and skills. Endoscopy nursing personnel should properly manage the instruments, equipment, and samples used in endoscopes and understand the basic knowledge of infection for its prevention and management. Therefore, a certain amount of pre-training time is required for endoscopy nursing personnel, who play an important role throughout the endoscopy procedure, and a program that is effectively configured for proper education is necessary. These training periods and programs should have established regulations for each institution, and the contents of the pre-training program should include understanding of endoscopy procedures and complications, nursing management for endoscopy examinees, infection control, and sedation management.

The six evaluation areas of the Accredited Endoscopy Unit Program are the qualification criteria for endoscopy doctors and nurses, facilities and equipment, endoscopy examination process, performance, disinfection and infection control, and endoscopic sedation. The assessment criteria for each evaluation area have been revised as follows: (1) upgrading assessment criteria; (2) qualification of endoscopists and reinforcement of quality control education; (3) detailed standards for safety, disinfection, endoscopic sedation, and management instructions are prepared; and (4) presentation of new performance measurement of endoscopy and colonoscopy. In this program, the credentialing of endoscopists requires that the endoscopist has specialized endoscopy training or performs a minimum number of procedures to demonstrate their competency. In addition, continuous education about endoscopy procedures and quality is required for unit staff.