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What do quality assessments have to do with practicing gastroenterologist? Why should one spend time and effort to incorporate endoscopic quality activities? First, quality improvement (QI) should directly benefit patients by ensuring they receive the highest quality of care possible. Recently, increasing the quality of endoscopy has become an important priority in Korea. Many quality indicators for gastrointestinal endoscopy have been published. Korean endoscopic quality standards were initially developed after a broad systematic review of other endoscopic quality guidelines and discussions with experts. The National Cancer Center and National Health Insurance Service (NHIS) organized the National Endoscopy QI Program in cooperation with the Korean Society of Gastrointestinal Endoscopy (KSGE). Quality standards have improved in the past 5 years, supported by the KSGE and NHIS. There has been great effort to improve endoscopic quality in other countries. In England, the Bowel Cancer Screening Programme (BCSP) was introduced in 2006, targeting a moderate risk population. The program is based on a biennial guaiac fecal occult blood test, and if the results are positive, patients are urged to undergo a colonoscopy after a 45-minute counseling session in a specialist nurse practitioner-led clinic. Additionally, all procedures are observed, timed, and centrally reported by an independent BCSP nurse practitioner. Emerging data show that colonoscopy within the BCSP is achieving exceptionally high quality assessment (QA) standards. In this issue of Clinical Endoscopy, Cho et al. report on the effects of the National Endoscopic QA Program on endoscopic practice and perceptions, burden on institutions, and costs of QA activities, especially from the viewpoint of medical institutions that conduct endoscopic screenings. A total of 67 institutions replied to the feedback survey of the National Endoscopic QA Program. They reported whether the QA program raised awareness for endoscopic quality (93%) or improved endoscopic practice (40%). Acceptable quality standards (45%) and incentives/reimbursement (38%) were considered important to the success of the QI program. In the survey, 52% of responders were conscious of considerable burdens and/or high costs while they prepared the endoscopic QA audit. While this study offered some promising results, it also revealed several issues that we must consider. First is the perception that QI was significantly enhanced at 93% of the medical institutions after the QA program was initiated. Approximately 80% of responders answered that all aspects of endoscopic quality had improved, including the qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedures and outcomes, and reproReceived: September 12, 2016 Revised: October 28, 2016 Accepted: October 31, 2016 Correspondence: Yoon Tae Jeen Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-920-6555, Fax: +82-2-953-1943, E-mail: ytjeen@korea.ac.kr

The Importance of an Endoscopic Quality Assessment Program Reflecting Real Practice