Appropriateness of colonoscopy requests according to EPAGE-II in the Spanish region of Catalonia (original) (raw)
Related papers
2012
Introduction: Colonoscopies are being requested with increasing frequency in the last few years, as they are used both as a diagnostic and therapeutic procedure in several gastrointestinal diseases. Our purpose is to describe the appropriateness of colonoscopy requests issued both from primary care centres and from hospitals, according to the EPAGE II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy).
Colonoscopy appropriateness: Really needed or a waste of time?
World journal of gastrointestinal endoscopy, 2015
Technical and quality improvements in colonoscopy along with the widespread implementation of population screening programs and the development of open-access units have resulted in an exponential increase in colonoscopy demands, forcing endoscopy units to bear an excessive burden of work. The American Society for Gastrointestinal Endoscopy appropriateness guideline and the European panel appropriateness of gastrointestinal endoscopy guideline have appeared as potential solutions to tackle this problem and to increase detection rates of relevant lesions. Inappropriate indications based on either guideline are as high as 30%. Strategies based on these clinical criteria or other systems may be used to reduce inappropriate indications, thus decreasing waiting lists for outpatient colonoscopy, saving costs, prioritizing colonoscopy referrals and subsequently decreasing interval times from diagnosis to treatment. Despite the potential role of appropriateness guidelines, they have not bee...
BMC Gastroenterology
Background: Due to finite resources, the clinical decision to subject a patient to colonoscopy needs to be based on the evidence, regardless of its availability, affordability and safety. This study assessed the appropriateness of colonoscopies conducted in selected study settings in Sri Lanka. In the absence of local guidelines, audit was based on European Panel on Appropriateness of Gastrointestinal Endoscopy II (EPAGE II) criteria. Methods: This cross-sectional study assessed consecutive patients who underwent colonoscopy between June to August 2015 at four main hospitals in Sri Lanka. Interviewer administered questionnaire and secondary data were collected by trained health staff. Indications were assessed according to EPAGE II criteria. Results: Out of 325 patients, male female proportions were 57.2 and 42.8%. Mean (SD) age was 54.9 (12.1) years. Colonoscopies were appropriate in 61.2% (95% CI 55.8-66.3), uncertain in 28.6% (95% CI 23.9-33.7) and inappropriate in 10.2% (95% CI 7.3-13.9). Colonoscopy to evaluate abdominal pain has highest percentage of inappropriateness of 10.0%. However, 9.5% of these colonoscopies revealed Colo-Rectal Cancer (CRC), reflecting differences in the profile of local CRC patients. Colonoscopies with appropriate or uncertain indications are three times more likely to have a relevant finding than inappropriate indications (42.5% vs. 18.2%; OR 3.32, 95% CI 1.33-8.3; P = 0.008). Conclusions: Majority of colonoscopies are appropriate. However, it cannot be neglected that every one in ten patients undergo inappropriate colonoscopy. Proportion of inappropriateness was highest for the indication of chronic abdominal pain, of which, 9.5% of patients were diagnosed with CRC. This may reflect the different profile of local CRC patients in terms of symptom manifestation and other characteristics. In conclusion, the authors recommend formulation of national guidelines for colonoscopy indications based on current best evidence and local patient profile. Use of such prepared local guidelines will improve the efficient use of finite resources.
Diseases of the Colon & Rectum, 2007
PURPOSE: The introduction of reimbursement for screening colonoscopy in Germany more than one year ago raised concerns that the consequent workload might lead to underuse of diagnostic colonoscopy for symptomatic patients. Available appropriateness criteria for diagnostic colonoscopy have been rarely tested in a realistic outpatient setting. This study was designed to test current appropriateness criteria for diagnostic colonoscopy to better select patients and potentially provide more capacity for screening cases. Secondary goals were yield and quality control in both the diagnostic and screening cases. METHODS: A prospective study was initiated in 39 private-practice offices to collect data on consecutive colonoscopies conducted during a 6-day study period. A detailed questionnaire was developed to define indications and symptoms, and all findings at colonoscopy were recorded. Colonoscopies were further analyzed and stratified into a screening and a diagnostic group. In the diagnostic group, indications were assessed according to the current guidelines for appropriateness (American Society for Gastrointestinal Endoscopy, European Panel for the Appropriateness of Gastrointestinal Endoscopy), and the results were correlated with the percentage of relevant findings (tumors, inflammatory conditions). RESULTS: During the study period, 1,397 colonoscopies (57 percent screening, 43 percent diagnostic) were analyzed (male/female ratio = 39/61 percent; mean age, 61 years). Fourteen percent and 37 percent, respectively, of the 605 diagnostic colonoscopies were regarded as inappropriate relative to the criteria of the American Society for Gastrointestinal Endoscopy and the European Panel for the Appropriateness of Gastrointestinal Endoscopy. However, the percentage of relevant inflammatory and neoplastic findings (polyps, cancer, inflammatory bowel disease, benign strictures) was only 5 to 10 percent higher in the appropriate group than in the inappropriate group. On the basis of these data, a hypothetical model for selecting appropriate indications
Appropriateness of colonoscopy in Europe (EPAGE II)
Endoscopy, 2009
Introduction ! Cancer of the colon and rectum (colorectal cancer [CRC]) is one of the most common cancers diagnosed in Western countries and the second most common cause of cancer deaths . It is generally accepted that most CRCs develop through a continuous process from normal mucosa to benign adenoma and then to carcinoma [3 -5]. While nearly all CRCs arise from adenomas, only a small minority of adenomas progress to cancer. Adenomas with advanced features, i. e. > 1 cm in diameter, with high-grade dysplasia, with > 25 % villous histology, or with invasive cancer, have the highest potential for malignancy. The removal of adenomas, by endoscopic polypectomy or surgical resection, is thus recommended to prevent CRC. After polypectomy, individuals are placed under colonoscopic surveillance to reduce the risk of development of and death from CRC, by detection and removal of new adenomas at surveillance colonoscopy. However, the overall prevalence of adenomas in the population is high (̃30 % at age 50 and̃50 % at age 70) and a large number of patients with adenomas are now being identified as a result of the increased use of CRC screening, particularly the dramatic increase in screening colonoscopy, thus placing a huge burden on medical resources applied to surveillance. There is a need for increased efficiency of surveillance colonoscopy practice, to decrease the cost, risk, and overuse of resources for inappropriate examinations. After diagnosis of CRC, between 66 % and 85 % of cancers can be surgically resected with curative intent [6 -8]. After CRC resection, patients are Background and study aims: To summarize the published literature on assessment of appropriateness of colonoscopy for surveillance after polypectomy and after curative-intent resection of colorectal cancer (CRC), and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. Methods: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of surveillance colonoscopy after polypectomy and after resection of CRC was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. Results: Most CRCs arise from adenomatous polyps. The characteristics of removed polyps, especially the distinction between low-risk adenomas (1 or 2, small [< 1 cm], tubular, no highgrade dysplasia) vs. high-risk adenomas (large [≥ 1 cm], multiple [> 3], high-grade dysplasia or villous features), have an impact on advanced
Open Journal of Gastroenterology
Background and Aims: Diagnostic colonoscopy allows exploration of the colonic mucosa. Indications are multiple. The purpose of this work was to describe the indications and to report the lesions observed during colonoscopy at the General Hospital of Douala. Methods: This was a cross-sectional study with retrospective data collection over a period of 7 years (January 1, 2010 to January 31, 2017). The data collected from the reports were socio-demographic characteristics, indications and lesions observed at colonoscopy. Binary logistic regression allowed us to identify the independent risk factors associated with the presence of tumors and polyps. Results: We included 719 exams. The main indications were rectorrhagia (29.5%), abdominal pain (25.9%) and constipation (17.8%). A colonic lesion was found in 60.1% of cases. A colorectal tumor accounted for 10.3% of cases. Factors independently associated with colonic tumor were complete colonoscopy (aOR: 0.167 95% CI [0.096-0.289], p < 0.001), presence of abdominal or rectal mass (aOR: 13.390 95% CI) [5.684-31.544], p < 0.001) and weight loss (aOR: 5.143, 95% CI [2.450-10.797], p < 0.001). Conclusion: The presence of weight loss, abdominal or rectal mass should motivate the realization of a complete colonoscopy in search of a colorectal tumor. The most observed lesions remain hemorrhoids, polyps and diverticulosis of the colon.
Characteristics of the Patients Undergoing Colonoscopy in a Single Center within an 8-year Period
Journal of Gastrointestinal & Digestive System, 2017
Aim: To evaluate patient characteristics by reviewing colonoscopy procedures performed within an 8-year period in the endoscopy centre of a training and research hospital. Methods: Colonoscopy procedures that were performed for various indications between 2002 and 2009 in the endoscopy unit of our hospital were retrospectively evaluated. Of 3035 colonoscopy procedures, 2831 were included in the analysis. In addition to demographic characteristics of the patients, presence and localization of colorectal masses, presence of inflammatory bowel disease, frequency of presence of hemorrhoids, diverticula, polyps, and other diseases, as well as complications were recorded. Results: The mean age of the patients (male, 50.5%) was 54.36 ± 15.05 years (range, 16-93 years). While a pathological finding was determined in 1512 (53.4%) colonoscopy procedures, 1319 (46.6%) colonoscopy procedures were reported as normal. Concerning complications during examinations, perforation was encountered in two patients and major bleeding was not determined in any of the patients. The most common diagnoses were polyps (15.9%) and hemorrhoids (15.9%), followed by colorectal mass (12.9%), diverticula (6.8%), and inflammatory bowel disease (5.6%). Conclusion: The fact that colorectal masses ranked third among the colonoscopic diagnoses suggested that cancer screening programs should be handled nationally.