対策型胃内視鏡検診の精度管理と安全対策

Quality Control and Risk Management for Population-based Endoscopic Gastric Cancer Screening

要旨●胃内視鏡検診の精度管理で重要なのは，専門医による内視鏡画像のダブルチェックである．それによって偽陰性率が低下し，生検率（要精検率）も低下する．内視鏡検診で重要な偶発症は鎮静薬の使用による呼吸抑制と生検による出血である．不必要な生検を避けることは，要精検率の低下だけではなく偶発症の減少にもつながる．頻度の高い偶発症に対するマニュアルを各施設で作成すべきであり，重篤な偶発症が発生した場合は自治体や胃内視鏡検診運営委員会（仮称）への報告が必要である．内視鏡機器の洗浄・消毒はE. H. Spauldingの分類に従い，自動洗浄消毒装置や超音波洗浄装置などを用いた十分な洗浄とすすぎ，高水準消毒薬を使用した消毒・滅菌，乾燥とその後の適切な衛生管理が必要である．

　Quality control in endoscopic gastric cancer screening warrants the peer review of endoscopic images by a specialist because it reduces the biopsy rate（recall rate）and false-negatives. Endoscopic screening is accompanied with significant risks, including respiratory depression secondary to sedatives and biopsy-related bleeding. The avoidance of unnecessary biopsies reduces the recall rate and the procedure-related risks（harms）. Thus, each facility should be equipped with manuals delineating the common procedure-related risks. Any occurrence of complications should be reported to the responsible municipality and/or the endoscopic gastric cancer screening board. The classification proposed by E. H. Spaulding necessitates cleaning and disinfecting endoscopic equipment with sufficient washing and rinsing using automatic washing, disinfecting, ultrasonic cleaning equipment, besides disinfection and sterilization using high-grade, potent disinfectants, adequate drying, and appropriate hygiene control.