The European panel on the appropriateness of gastrointestinal endoscopy guidelines colonoscopy in an open-access endoscopy unit: a prospective study.
ABSTRACT The demand for gastrointestinal endoscopy is increasing in most developed countries, resulting in an important rise in overall costs and waiting lists for endoscopic procedures. Therefore, adherence to appropriate indications for these procedures is essential for the rational use of finite resources in an open-access system.
To assess indications and appropriateness of colonoscopy according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria.
From May to June 2004, all consecutive patients referred to our Unit for open-access colonoscopy were considered for inclusion in this prospective study. Appropriateness of each colonoscopy was established according to the EPAGE criteria. In order to evaluate whether appropriateness of use correlated with the diagnostic yield of colonoscopy, relevant endoscopic findings were also recorded.
A total of 350 consecutive patients were included in the study. In 38 of them, the colonoscopy indication was not listed in the EPAGE guidelines and, consequently, they were not evaluated. In the remaining 312 patients, the indication for the procedure was considered inappropriate in 73 (23%) patients. Both referring doctor characteristics (specialty and health care setting) and patient data (age) correlated with appropriateness of endoscopy. The diagnostic yield was significantly higher for appropriate colonoscopies (42%) than in those judged inappropriate (21%) (P = 0.001).
A noteworthy proportion of patients referred for colonoscopy to an open-access endoscopy unit are considered inappropriate because of their indication, with significant differences among specialties. These results suggest that implementation of validated guidelines for its appropriate use could improve this situation and, considering the correlation between appropriateness and diagnostic yield, even contribute to improve the prognosis of patients with colorectal diseases.
- SourceAvailable from: epage.chEndoscopy 11/1999; 31(8):687-94. · 5.74 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Open access colonoscopy for patients with suspected colonic disease is often not practical and some form of patient selection may be necessary. One year's colonoscopic data from our unit were analysed to determine the major indications for the procedure and the diagnostic yield, and to evaluate the suitability of colonoscopy for each indication. The seven major indications were rectal bleeding, iron deficiency anaemia, cancer follow-up, polyp follow-up, abdominal pain, abnormal bowel habit and 'other'. Four hundred and forty-eight procedures were included in the analysis, with rectal bleeding, polyp follow-up and iron deficiency anaemia producing the highest diagnostic yields of 69.1%, 53.3% and 47.7% respectively. Lower yields were obtained for cancer follow-up (21%), abdominal pain (38.2%) and abnormal bowel habit (46.8%). The indication, 'other', produced a combined yield of 66.7%; the majority of patients in this group were known to have colitis. On the basis of these findings we propose that where facilities and expertise do not allow for routine colonoscopy, some form of patient selection should be employed and we believe this selection should take place according to the diagnostic yield for each indication.South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 05/1993; 83(4):245-8. · 1.70 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Since Medicare approval for reimbursement of screening colonoscopies, the number of colonoscopy requests has increased. Physician resources have often been inadequate to meet the demand. We sought to reduce the demand for colonoscopy in an open endoscopy system by using a guideline-based triage system to eliminate inappropriate procedures and to align the timing of surveillance colonoscopies with recommendations made by national organizations. This was a cohort study with primary care outpatients. From October 2002 to February 2003, 498 consecutive patients on a waiting list of 2400 awaiting colonoscopy for all indications were triaged and are the focus of the study. Selection of patients for appropriate colonoscopy was based on consensus guidelines developed for institutional use by using established published guidelines for appropriate colonoscopy indications. Of the 498 consecutive patients triaged, 139 (28%) were deemed inappropriate. The most common reason was inappropriate referral for surveillance of colorectal polyps. The percentage of inappropriate referrals by the 3 largest referring specialties (internal medicine, family medicine, and gastroenterology) combined was also 28% with no statistically significant differences between specialties. Most referrals for colonoscopy in an open-access endoscopy system were appropriate, although about 1 in 4 were not. Use of triage and further education of physicians regarding colonoscopy may optimize colonoscopy utilization.Clinical Gastroenterology and Hepatology 03/2004; 2(2):178-82. · 6.65 Impact Factor