Appropriateness Of Gastrointestinal Endoscopy Research Articles

Factors Associated with the Applicability of EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) and the Suitability of Indications for Eso-Gastroduodenal Endoscopy in a West African Country

Background: EGDF’s reference examination for exploring the digestive tract has seen steadily increasing demands over the past few years. The exam can be expensive and often poorly tolerated. Its prescription must take the cost/be- nefit and its relevance into account. The EPAGE criteria were developed to allow the appropriate selection of endoscopic procedures. Objective: To determine the factors associated with the applicability and appropriateness of the EGDF indications by the EPAGE criteria in our context in order to limit the number of inadequate EGDFs. Material and Method: Prospective cross- sectional study on the applicability of EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) and the relevance of the indications for Eso-Gastro-Duodenal Fibroscopy (EGDF) according to the criteria of the EPAGE in two large public hospitals located in the central region of Ivory Coast over a period of 8 months from September 2019 to May 2020. The following parameters (age, sex, history and comorbidities of the patient, the indication of EGDF, the qualification of the prescriber, the EPAGE situation, the relevance of the indications according to EPAGE, the result of the EGDF) were collated classified into judgment criteria and analyzed via the site https://www.epage.ch/ depending on whether the indication was appropriate, uncertain or inappropriate. The difference was significant for a value of p ≤ 0.05. Results: This was 1010 EGDF. The indications for EGDF were epigastralgia, gastrointestinal haemorrhage, testing for PHT signs, heartburn, vomiting, dysphagia, chest pain, anemia, control, tumor assessment. The result of EGDF was normal (14.9%), non-significant lesions (47.5%) and significant lesions (37.6%). EPAGE was applicable in 93.8% of patients, and the indications for EGDF were considered appropriate in 54.2% of cases. The EPAGE criteria were significantly applicable and appropriate in cases of epigastralgia, digestive haemorrhage, heartburn, and vomiting but not applicable for the search for signs of PH, for non-significant lesions and for 1/3 of gastric cancer. Significant lesions predominated in patients with appropriate indications (p Conclusion: In our context, the EPAGE criteria could constitute a useful tool for the diagnostic profitability of EGDF. The indications deemed appropriate are statically associated with significant lesions and advanced age. But EPAGE must be adapted to our indications and cannot replace the reasoning of the practitioner when faced with the suspicion of significant lesions.

Systematic review with meta-analysis: the appropriateness of colonoscopy increases the probability of relevant findings and cancer while reducing unnecessary exams.

Colonoscopy is frequently performed in industrialised countries. Inappropriate colonoscopies might lead to unnecessary exams, increasing risks and costs. To estimate the impact of colonoscopy appropriateness in terms of gain in additional diagnoses and sparing of unnecessary exams. Systematic review including studies reporting the prevalence of relevant findings, colorectal cancer (CRC) and inflammatory bowel disease (IBD) according to colonoscopy appropriateness as defined by the American Society for Gastrointestinal Endoscopy and European Panel on Appropriateness of Gastrointestinal Endoscopy. Twenty-one studies with 19,822 patients were included. Colonoscopy was appropriate in 15,162 (71%, CI 64%-78%). Appropriateness significantly increased the probability of relevant findings (34% vs. 18%; RR 1.81, CI 1.53-2.14), CRC (7% vs. 2%; RR 3.62, CI 2.44-5.37) and IBD (6% vs. 4%; RR 1.86, CI 1.09-3.19). Appropriateness had sensitivity 88% (CI 85%-91%), 97% (CI 93%-98%) and 89% (CI 80%-94%), and specificity 24% (CI 20%-29%), 22% (CI 18%-26%) and 24% (CI 20%-28%) for relevant findings, CRC and IBD, respectively. On average, performing colonoscopy with appropriate indication would find 15 (CI 10-21) more relevant findings, five (CI 3-9) more CRCs and three (CI 1-9) more diagnoses of IBD per 100 patients, and save 24 (CI 20-29), 22 (CI 18-26) and 24 (CI 20-28) examinations per 100 patients for relevant findings, CRC and IBD, respectively. Appropriateness affects the diagnostic yield of colonoscopy for CRC, IBD and relevant findings. Appropriateness criteria are useful, although integrated with clinical evaluation of the patient.

Appropriateness of colonoscopy requests according to EPAGE-II in the Spanish region of Catalonia.

BackgroundIn a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion. The objective of this study is to evaluate the appropriateness of colonoscopy requests performed in a primary care (PC) setting in Catalonia.MethodsCross-sectional descriptive study. Out-patients >14 years of age, referred by their reference physicians from PC or hospital care settings to the endoscopy units in their reference hospitals, to undergo a colonoscopy. Evaluation of the appropriateness of 1440 colonoscopy requests issued from January to July 2011, according to the EPAGE-II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy).ResultsThe most frequent indications of diagnostic suspicion requests were: rectal bleeding (37.46 %), abdominal pain (26.54 %), and anaemia study (16.78 %). The most frequent indications of disease follow-up were adenomas (58.1 %), and CRC (31.16 %). Colonoscopy was appropriate in 73.68 % of the cases, uncertain in 16.57 %, and inappropriate in 9.74 %. In multivariate analysis, performed colonoscopies reached an OR of 9.9 (CI 95 % 1.16–84.08) for qualifying as appropriate for colorectal cancer (CRC) diagnosis, 1.49 (CI 95 % 1.1–2.02) when requested by a general practitioner, and 1.09 (CI 95 % 1.07–1.1) when performed on women.ConclusionsAppropriateness of colonoscopy requests in our setting shows a suitable situation in accordance with recognized standards. General practitioners contribute positively to this appropriateness level. It is necessary to provide physicians with simple and updated guidelines, which stress recommendations for avoiding colonoscopy requests in the most prevalent conditions in PC.

Diagnostic yield of endoscopy in patients with abdominal complaints: incremental value of faecal calprotectin on guidelines of appropriateness

BackgroundEuropean Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria have been developed to increase diagnostic yield, but their predictive value is limited. We investigated the incremental diagnostic value of faecal calprotectin to EPAGE criteria.MethodsIn a post-hoc analysis of a prospective study, EPAGE criteria were applied to 298 of 575 (51.8%) patients who had undergone esophagogastroduodenoscopy (EGD), colonoscopy or both for abdominal complaints at the Division of Gastroenterology & Hepatology at the University Hospital Basel in Switzerland. Faecal calprotectin was measured in stool samples collected within 24 hours before the investigation using an enzyme-linked immunosorbent assay. Final endoscopic diagnoses were blinded to calprotectin values.ResultsOf 149 EGDs and 224 colonoscopies, 17.6% and 14.7% respectively were judged inappropriate by EPAGE criteria. Appropriate or uncertain indications revealed more endoscopic findings in both EGD (46.3% vs. 23.1%, P = 0.049) and colonoscopy (23.6% vs. 6.1%, P = 0.041) than inappropriate indications. Median calprotectin levels were higher (81.5 μg/g, interquartile range 26-175, vs. 10 μg/g, IQR 10–22, P < 0.001) and testing was more often positive (>50 μg/g) in patients with endoscopic findings, both in EGD (58.2% vs. 33.0%, P = 0.005) and in colonoscopy (57.3% vs. 7.4%, P < 0.001). The use of faecal calprotectin in addition to EPAGE criteria improved the risk reclassification of patients by endoscopic findings. The calculated net reclassification index was 37.8% (P = 0.002) for EGD and 110.9% (P <0.001) for colonoscopy, thus improving diagnostic yield to 56.8% and 70.2%, respectively.ConclusionsThe use of faecal calprotectin in addition to EPAGE criteria improved diagnostic yield in patients with abdominal complaints.

Appropriateness of colonoscopy in Cocody teaching hospital center in 2010: A prospective study using criteria established by the European panel on the appropriateness of gastrointestinal endoscopy (EPAGE)

Aims: 1) To assess the feasibility of EPAGE criteria in clinical practice; 2) To assess appropriateness colonoscopy using EPAGE criteria; 3) To compare colonoscopy appropriateness and endoscopic lesions. Method: Hundred thirtynine consecutive patients explored by colonoscopy were included. The appropriateness of colonoscopy was evaluated by EPAGE criteria. Results: EPAGE criteria were applicable among 127 patients (91% of the cases). Colonoscopies were appropriate, uncertain and inappropriate in respectively 40%; 27% and 24% of the cases. Rate of abnormal colonoscopies was significantly different between the 3 groups (p = 0.03). Cancers were diagnosed exclusively in the groups with appropriate and uncertain colonoscopies (11% and 5%). Colonic adenomas were observed in the three groups (appropriate (7%), uncertain (5%) and inappropriate (6%)). Subjects with uncertain indication were older (58.25 years; p = 0.035). Conclusion: EPAGE criteria are feasible in clinical practice in Cocody’s teaching hospital center. Colonoscopies are generally appropriate in our hospital. However, within sight of the significant number of normal colonoscopies and discovered lesions in uncertain indication, colonoscopy cannot concern exclusively calculation of a score of appropriateness.

A cross-sectional study of the appropriateness of colonoscopy requests in the Spanish region of Catalonia

IntroductionColonoscopies 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...

Clinical validation of the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) II criteria in an open-access unit: a prospective study

The European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE I) criteria were recently updated (EPAGE II), but no prospective studies have used these criteria in clinical practice. The aim of the current study was to validate the EPAGE II criteria in an open-access endoscopy unit. A prospective observational study was conducted in an open-access endoscopy unit at a tertiary care referral center. Consecutive outpatients (n = 1004; mean age 58.9 ± 13.1 years; 45 % men) were referred for diagnostic colonoscopy between September 2009 and February 2010. The appropriateness of colonoscopy was assessed based on EPAGE II criteria, and the relationship between appropriateness and both referral doctor and detection of significant lesions was examined. The effectiveness of EPAGE II criteria in assessing appropriateness was measured by means of sensitivity, specificity, and positive and negative predictive values for detecting significant lesions. Colonoscopic cecal intubation was achieved in 956 patients (95.2 %). Most referral doctors were gastroenterologists (58.0 %) and the most common indication was colorectal cancer (CRC) screening (35.2 %). EPAGE II criteria were applicable in 968 patients (96.4 %); of these patients, the indication was appropriate in 778 (80.4 %), inappropriate in 102 (10.5 %), and uncertain in 88 (9.1 %). Patients with appropriate or uncertain indications based on EPAGE II criteria had more relevant endoscopic findings than those with inappropriate indications (38.8 % vs. 24.5 %; OR 1.95, 95 %CI 1.22 - 3.13; P < 0.005). Sensitivity and negative predictive value of EPAGE II criteria for detecting significant lesions were 93.1 % (95 %CI 90 % - 96 %) and 75.5 % (95 %CI 67 % - 84 %), respectively, whereas for advanced neoplastic lesions these values were 98.0 % (95 %CI 95 % - 100 %) and 98.0 % (95 % CI 95 % - 100 %), respectively. Adherence to EPAGE II recommendations was an independent predictor of finding a significant lesion (OR 1.93, 95 %CI 1.20 - 3.11; P = 0.007). EPAGE II is a simple, valid score for detecting inappropriate colonoscopies in clinical practice.

Appropriateness of colonoscopy in Europe (EPAGE II) – Functional bowel disorders: pain, constipation and bloating

To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of functional bowel symptoms, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of functional bowel symptoms was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. Much of the evidence for use of colonoscopy in evaluation of chronic abdominal pain, and/or constipation and/or abdominal bloating is modest. Major limitations include small numbers of patients and lack of adequate characterization of these patients. Large community-based follow-up studies are needed to enable better definition of the natural history of patients with functional bowel disorders. Guidelines stress that alarm features ("red flags"), such as rectal bleeding, anemia, weight loss, nocturnal symptoms, family history of colon cancer, age of onset > 50 years, and recent onset of symptoms should all lead to careful evaluation before a diagnosis of functional bowel disorder is made. EPAGE II assessed these symptoms by means of 12 clinical scenarios, rating colonoscopy as appropriate, uncertain and inappropriate in 42 % (5/12), 25 % (3/12), and 33 % (4/12) of these, respectively. Evidence to support the use of colonoscopy in the evaluation of patients with functional bowel disorders and no alarm features is lacking. These patients have no increased risk of colon cancer and thus advice on screening for this is not different from that for the general population. EPAGE II criteria, available online (http://www.epage.ch), consider colonoscopy appropriate in patients of > 50 years with chronic or new-onset bowel disturbances, but not in patients with isolated chronic abdominal pain.

Appropriateness of colonoscopy in Europe (EPAGE II) – Screening for colorectal cancer

To summarize the published literature on assessment of appropriateness of colonoscopy for screening for colorectal cancer (CRC) in asymptomatic individuals without personal history of CRC or polyps, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. A systematic search of guidelines, systematic reviews, and primary studies regarding colonoscopy for screening for colorectal cancer was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy in these circumstances. Available evidence for CRC screening comes from small case-controlled studies, with heterogeneous results, and from indirect evidence from randomized controlled trials (RCTs) on fecal occult blood test (FOBT) screening and studies on flexible sigmoidoscopy screening. Most guidelines recommend screening colonoscopy every 10 years starting at age 50 in average-risk individuals. In individuals with a higher risk of CRC due to family history, there is a consensus that it is appropriate to offer screening colonoscopy at < 50 years. EPAGE II considered screening colonoscopy appropriate above 50 years in average-risk individuals. Panelists deemed screening colonoscopy appropriate for younger patients, with shorter surveillance intervals, where family or personal risk of colorectal cancer is higher. A positive FOBT or the discovery of adenomas at sigmoidoscopy are considered appropriate indications. Despite the lack of evidence based on randomized controlled trials (RCTs), colonoscopy is recommended by most published guidelines and EPAGE II criteria available online (http://www.epage.ch), as a screening option for CRC in individuals at average risk of CRC, and undisputedly as the main screening tool for CRC in individuals at moderate and high risk of CRC.

Appropriateness of colonoscopy in Europe (EPAGE II) – Presentation of methodology, general results, and analysis of complications

Appropriate use of colonoscopy is a key component of quality management in gastrointestinal endoscopy. In an update of a 1998 publication, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE II) defined appropriateness criteria for various colonoscopy indications. This introductory paper therefore deals with methodology, general appropriateness, and a review of colonoscopy complications. The RAND/UCLA Appropriateness Method was used to evaluate the appropriateness of various diagnostic colonoscopy indications, with 14 multidisciplinary experts using a scale from 1 (extremely inappropriate) to 9 (extremely appropriate). Evidence reported in a comprehensive updated literature review was used for these decisions. Consolidation of the ratings into three appropriateness categories (appropriate, uncertain, inappropriate) was based on the median and the heterogeneity of the votes. The experts then met to discuss areas of disagreement in the light of existing evidence, followed by a second rating round, with a subsequent third voting round on necessity criteria, using much more stringent criteria (i. e. colonoscopy is deemed mandatory). Overall, 463 indications were rated, with 55 %, 16 % and 29 % of them being judged appropriate, uncertain and inappropriate, respectively. Perforation and hemorrhage rates, as reported in 39 studies, were in general < 0.1 % and < 0.3 %, respectively The updated EPAGE II criteria constitute an aid to clinical decision-making but should in no way replace individual judgment. Detailed panel results are freely available on the internet (www.epage.ch) and will thus constitute a reference source of information for clinicians.

Appropriateness of colonoscopy in Europe (EPAGE II) – Surveillance after polypectomy and after resection of colorectal cancer

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. 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. 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 high-grade dysplasia) vs. high-risk adenomas (large [> or = 1 cm], multiple [> 3], high-grade dysplasia or villous features), have an impact on advanced adenoma recurrence. Most guidelines recommend a 3-year follow-up colonoscopy for high-risk adenomas and a 5-year colonoscopy for low-risk adenomas. Despite the lack of evidence to support or refute any survival benefit for follow-up colonoscopy after curative-intent CRC resection, surveillance colonoscopy is recommended by most guidelines. The timing of the first surveillance colonoscopy differs. The expert panel considered that 56 % of the clinical indications for colonoscopy for surveillance after polypectomy were appropriate. For surveillance after CRC resection, it considered colonoscopy appropriate 1 year after resection. Colonoscopy is recommended as a first-choice procedure for surveillance after polypectomy by all published guidelines and by the EPAGE II criteria. Despite the limitations of the published studies, colonoscopy is also recommended by most of the guidelines and by EPAGE II criteria for surveillance after curative-intent CRC resection.

Appropriateness of colonoscopy in Europe (EPAGE II) – Chronic diarrhea and known inflammatory bowel disease

To summarize the published literature on assessment of appropriateness of colonoscopy for investigation of chronic diarrhea, management of patients with known inflammatory bowel disease (IBD), and for colorectal cancer (CRC) surveillance in such patients, and to report report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. A systematic search of guidelines, systematic reviews, and primary studies regarding the evaluation of chronic diarrhea, the management of IBD, and colorectal cancer surveillance in IBD was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. According to the literature, colonoscopic evaluation may be justified for patients aged > 50 years with recent-onset chronic diarrhea or with alarm symptoms. Surveillance colonoscopy for CRC should be offered to all patients with extensive ulcerative colitis or colonic Crohn's disease of 8 years' duration, and to all patients with less extensive disease of 15 years' duration. Intervals for surveillance colonoscopy depend on duration of evolution, initial diagnosis, and histological findings. The EPAGE II criteria also confirmed the appropriateness of diagnostic colonoscopy for diarrhea of > 4 weeks' duration. They also suggest that, in addition to assessing extent of IBD by colonoscopy, further colonoscopic examination is appropriate in the face of persistent or worsening symptoms. Surveillance colonoscopy in IBD patients was generally appropriate after a lapse of 2 years. In the presence of dysplasia at previous colonoscopy, it was not only appropriate but necessary. Despite or perhaps because of the limitations of the available published studies, the panel-based EPAGE II (http://www.epage.ch) criteria can help guide appropriate colonoscopy use in the absence of strong evidence from the literature.

Appropriateness of colonoscopy in Europe (EPAGE II) – Iron-deficiency anemia and hematochezia

To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of iron-deficiency anemia (IDA) and hematochezia, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of IDA and hematochezia was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. IDA occurs in 2 %-5 % of adult men and postmenopausal women. Examination of both the upper and lower gastrointestinal tract is recommended in patients with iron deficiency. Colonoscopy for IDA yields one colorectal cancer (CRC) in every 9-13 colonoscopies. Hematochezia is a well-recognized alarm symptom and such patients are likely to be referred for colonoscopy. Colonoscopy is unanimously recommended in patients aged > or = 50. Diverticulosis, vascular ectasias, and ischemic colitis are common causes of acute lower gastrointestinal bleeding (LGIB); CRC is found in 0.2 %-11 % of the colonoscopies performed for LGIB. Most patients with scant hematochezia have an anorectal or a distal source of bleeding. The expert panel considered most clinical indications for colonoscopy as appropriate in the presence of IDA (58 %) or hematochezia (83 %). Despite the limitations of the published studies, guidelines unanimously recommend colonoscopy for the investigation of IDA and hematochezia in patients aged > or = 50 years. These indications were also considered appropriate by EPAGE II, as were indications in patients at low risk for CRC with no obvious cause of bleeding found during adequate previous investigations.

The appropriateness of colonoscopy: a multi-center, international, observational study

To examine the appropriateness and necessity of colonoscopy across Europe. Prospective observational study. A total of 21 gastrointestinal centers from 11 countries. Consecutive patients referred for colonoscopy at each center. Appropriateness criteria developed by the European Panel on the Appropriateness of Gastrointestinal Endoscopy, using the RAND appropriateness method, were used to assess the appropriateness of colonoscopy. Appropriateness of colonoscopy. A total of 5213 of 6004 (86.8%) patients who underwent diagnostic colonoscopy and had an appropriateness rating were included in this study. According to the criteria, 20, 26, 27, or 27% of colonoscopies were judged to be necessary, appropriate, uncertain, or inappropriate, respectively. Older patients and those with a major illness were more likely to have an appropriate or necessary indication for colonoscopy as compared to healthy patients or patients who were 45-54 years old. As compared to screening patients, patients who underwent colonoscopy for iron-deficiency anemia [OR: 30.84, 95% CI: 19.79-48.06] or change in bowel habits [OR: 3.69, 95% CI: 2.74-4.96] were more likely to have an appropriate or necessary indication, whereas patients who underwent colonoscopy for abdominal pain [OR: 0.64, 95% CI: 0.49-0.83] or chronic diarrhea [OR: 0.54, 95% CI: 0.40-0.75] were less likely to have an appropriate or necessary indication. This study identified significant proportions of inappropriate colonoscopies. Prospective use of the criteria by physicians referring for or performing colonoscopies may improve appropriateness and quality of care, especially in younger patients and in patients with nonspecific symptoms.

Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE)

Screening for colorectal cancer (CRC) has been shown to decrease mortality. To examine determinants associated with having (1) a screening colonoscopy, (2) an appropriate indication for screening, and (3) a significant diagnosis at screening. Prospective observational study. Twenty-one endoscopy centers from 11 countries. Asymptomatic patients who underwent a colonoscopy for the purpose of detecting CRC and who did not have a history of polyps or CRC, a lesion observed at a recent barium enema or sigmoidoscopy, or a recent positive fecal occult blood test. Screening colonoscopy. Appropriateness according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria and significant diagnoses (cancer, adenomatous polyps, new diagnoses of inflammatory bowel disease, angiodysplasia). Of 5069 colonoscopies, 561 (11%) were performed for screening purposes. Patients were more likely to have a screening colonoscopy if they were aged 45 to 54 years (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.60-3.99). Screening colonoscopies were appropriate, uncertain, and inappropriate in 26%, 60%, and 14% of cases, respectively. Eighty-one significant diagnoses were made, including 4 cancers. Significant diagnoses were more often made for uncertain/appropriate indications (OR 3.20, 95% CI 1.12-9.17) than for inappropriate indications. Although data completeness was asked of all centers, it is possible that not all consecutive patients were included. Participating centers were a convenience sample and thus may not be representative. About 1 of 10 colonoscopies were performed for screening, preferentially in middle-aged individuals. A higher diagnostic yield in uncertain/appropriate indications suggests that the use of appropriateness criteria may enhance the efficient use of colonoscopy for screening.

ASGE Criteria and EPAGE Method for the Appropriate Use of Colonoscopy: Which Is the Most Accurate?

Aim: The aim of this study was to compare the diagnostic performance (expressed as the accuracy in detecting relevant pathologies) of two systems for the evaluation of the appropriateness of colonoscopy suggested by the American Society of Gastrointestinal Endoscopy (ASGE) and by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE). Methods: Patients referred for Colonoscopy to an University outpatients Clinic of North-eastern Italy, were consecutively included in this prospective observational study. Before the procedure was performed the endoscopist assigned the patients to one of the ASGE appropriateness class; afterwards another gastroenterologist, without prior knowledge of the result of ASGE assignement, identified the detailed clinical scenario for the patients, which correspond to scenarios examined by EPAGE (see www.epage.ch), by using a 9-point scale: 1-3 inappropriate; 4-6 uncertain; 7-9 appropriate. The relationship between appropriateness of use and the presence of relevant endoscopic lesions (ischemic colitis, diverticulitis, Crohn's colitis, solitary ulcer of rectum, ulcerative colitis, neoformations, polyps, stenosis) was assessed, calculating the sensitivity and the specificity for each of the ASGE criteria, and each of the EPAGE score. Each couple of sensitivity/specificity data was plotted to form a so-called ROC curve. The area under the ROC curve (AUC) provides a summary measure of test performance, and can vary from 0.5 for a useless test to 1.0 for a very accurate test. We compared the AUC (and 95% CI) of the ROC curve derived from the application of ASGE criteria against that derived from the application of the EPAGE criteria. Results: 2006 consecutive patients were included in the study; comparison of appropriateness criteria according to ASGE and EPAGE could be made for 1843 patients (803 M and 1040 F; mean age 47; range 15-96). The AUC of the ROC curve derived from the ASGE criteria was 0.552 (95% CI: 0.521-0.583), not significantly different than the AUC of the ROC curve derived from the EPAGE score that was 0.568 (95% CI: 0.538-0.598. p = 0,3834). Conclusions: On the basis of our results we can suggest that the diagnostic accuracy for relevant pathologies obtained by both systems (ASGE and EPAGE) is unsatisfactory. Aim: The aim of this study was to compare the diagnostic performance (expressed as the accuracy in detecting relevant pathologies) of two systems for the evaluation of the appropriateness of colonoscopy suggested by the American Society of Gastrointestinal Endoscopy (ASGE) and by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE). Methods: Patients referred for Colonoscopy to an University outpatients Clinic of North-eastern Italy, were consecutively included in this prospective observational study. Before the procedure was performed the endoscopist assigned the patients to one of the ASGE appropriateness class; afterwards another gastroenterologist, without prior knowledge of the result of ASGE assignement, identified the detailed clinical scenario for the patients, which correspond to scenarios examined by EPAGE (see www.epage.ch), by using a 9-point scale: 1-3 inappropriate; 4-6 uncertain; 7-9 appropriate. The relationship between appropriateness of use and the presence of relevant endoscopic lesions (ischemic colitis, diverticulitis, Crohn's colitis, solitary ulcer of rectum, ulcerative colitis, neoformations, polyps, stenosis) was assessed, calculating the sensitivity and the specificity for each of the ASGE criteria, and each of the EPAGE score. Each couple of sensitivity/specificity data was plotted to form a so-called ROC curve. The area under the ROC curve (AUC) provides a summary measure of test performance, and can vary from 0.5 for a useless test to 1.0 for a very accurate test. We compared the AUC (and 95% CI) of the ROC curve derived from the application of ASGE criteria against that derived from the application of the EPAGE criteria. Results: 2006 consecutive patients were included in the study; comparison of appropriateness criteria according to ASGE and EPAGE could be made for 1843 patients (803 M and 1040 F; mean age 47; range 15-96). The AUC of the ROC curve derived from the ASGE criteria was 0.552 (95% CI: 0.521-0.583), not significantly different than the AUC of the ROC curve derived from the EPAGE score that was 0.568 (95% CI: 0.538-0.598. p = 0,3834). Conclusions: On the basis of our results we can suggest that the diagnostic accuracy for relevant pathologies obtained by both systems (ASGE and EPAGE) is unsatisfactory.

The EPAGE Internet Guideline as a Decision Support Tool for Determining the Appropriateness of Colonoscopy

Background: Few studies have examined how physicians perceive guidelines, much less their perceptions of an Internet presentation of such guidelines. This study assessed physicians’ acceptance ofan Internet-based guideline on the appropriateness of colonoscopy. Methods: Gastroenterologists participating in an international observational study consulted an Internet-based guideline for consecutive patients referred for colonoscopy. The guideline was produced by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE), using a validated method (RAND). Through the use of questionnaires, physicians were asked their opinions and perspectives of the guideline and website. Results: There were 289 patients included in the study. The mean time for consulting the website was 1.8 min, and it was considered easy to use by 86% of physicians. The recommendations were easily located for 82% of patients and physicians agreed with the appropriateness in 86% of cases. According to the EPAGE criteria, colonoscopy was appropriate, uncertain, and inappropriate in 59, 28, and 13% of patients, respectively. Conclusions: The EPAGE guideline was considered acceptable and user-friendly and the use, usefulness and relevance of the website were considered acceptable. However, its actual use will depend on the removal of certain organizational and cultural obstacles.

Comparison between the Two Systems to Evaluate the Appropriateness of Endoscopy of the Upper Digestive Tract

The aim of this study was to compare the diagnostic performance of the two systems for the evaluation of the appropriateness of upper digestive endoscopy suggested by the American Society of Gastrointestinal Endoscopy (ASGE) and by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE). Patients referred for the upper digestive endoscopy (EGD) to a University Outpatients Clinic of Northeastern Italy were consecutively included in this prospective observational study. Before the EGD, the endoscopist assigned the patients to one of the ASGE appropriateness classes; another endoscopist then identified the detailed clinical scenario for the patients, which corresponds to scenarios examined by EPAGE by using a nine-point scale: 1-3 inappropriate; 4-6 uncertain; and 7-9 appropriate. The relationship between the appropriateness of use and the presence of relevant endoscopic lesions (neoplasms, ulcers, esophagitis, erosive gastritis/duodenitis, stenosis, and varices) was assessed, calculating the sensitivity and the specificity for each of the ASGE criteria, and each of the EPAGE scores, and plotting them to form a receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) provides a summary measure of test performance, and can vary from a minimum of 0.5 to a maximum of 1.0. We compared the AUC of the ROC curve derived from the ASGE criteria against that derived from the EPAGE criteria. A total of 2,300 consecutive patients were included in the study (42% men; mean age: 57.3; range: 12-99); comparison of appropriateness criteria according to the ASGE and EPAGE could be made for 2,000 patients. The AUC of the ROC curve derived from the ASGE criteria was 0.553 (95% CI: 0.527-0.579), significantly higher than the AUC of the ROC curve derived from the EPAGE score: 0.523 (95% CI: 0.497-0.549; p < 0.05). We suggest that the diagnostic yield for relevant endoscopic findings obtained by both the systems (ASGE and EPAGE) is low; slightly better results could be accomplished by the ASGE criteria.

1 P Appropriateness of gastrointestinal endoscopy: A prospective observational study based on the American Society for Gastrointestinal Endoscopy (ASGE) guidelines

1 P Appropriateness of gastrointestinal endoscopy: A prospective observational study based on the American Society for Gastrointestinal Endoscopy (ASGE) guidelines

Appropriate use of upper gastrointestinal endoscopy: Comparative prospective study using guidelines of American society of gastrointestinal endoscopy and european panel on the appropriateness of gastrointestinal endoscopy

Appropriate use of upper gastrointestinal endoscopy: Comparative prospective study using guidelines of American society of gastrointestinal endoscopy and european panel on the appropriateness of gastrointestinal endoscopy