European panel on the appropriateness of gastrointestinal endoscopy II guidelines help in selecting and prioritizing patients referred to colonoscopy – a quality control study

Eskeland, Sigrun Losada; Dalén, Eirin; Sponheim, Jon; Lind, Even; Brunborg, Cathrine; Lange, Thomas de

doi:10.3109/00365521.2014.886715

Cited by 21 publications

(15 citation statements)

References 106 publications

(169 reference statements)

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“…In primary care practices in Switzerland, 14% of colonoscopy referrals and 49% of referrals for upper endoscopy represented overuse. 114,115 Elsewhere in Europe, appropriateness rates for endoscopy have been reported in Portugal, Spain, Italy, and Norway, with overuse accounting for between 13% and 33% of tests, 116–119 and at an Israeli center 16% of endoscopies were unnecessary. 120 Studies in the US have reported overuse rates as high as 60% 121 .…”

Section: Worldwide Prevalence Of Overusementioning

confidence: 99%

Evidence for overuse of medical services around the world

et al. 2017

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Section: Worldwide Prevalence Of Overusementioning

confidence: 99%

Evidence for overuse of medical services around the world

et al. 2017

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“…Assessing colonoscopy indications prospectively, and concluding whether or not colonoscopy results modified patient management, would provide further elements to determine whether colonoscopy requests were appropriate. However, studies that assess appropriateness of colonoscopy prospectively, obtain similar results [ 26 , 30 , 32 ].…”

Section: Discussionmentioning

confidence: 90%

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

et al. 2015

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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.

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“…As one example, a meta‐analysis has shown that the diagnostic OR of the American Society for Gastrointestinal Endoscopy and European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria for relevant findings was 2.5 (95% CI: 1.2–5.6), inferior to the OR of the FAST Score in both derivation and the validation cohorts. Further, although we cannot exclude relevant findings in the low risk group (PPV: 5.2–5.3%), the PPV in the inappropriate colonoscopy group according to the EPAGE II criteria ranges between 9.5 and 24.5% . Finally, it is quite clear that the main endpoint of endoscopic evaluation of symptomatic patients must be the detection, or perhaps more importantly, the exclusion of those clinical conditions that threaten or significantly affect the quality of life, especially on account of the limited endoscopic resources available in many countries.…”

Section: Discussionmentioning

confidence: 93%

The fecal hemoglobin concentration, age and sex test score: Development and external validation of a simple prediction tool for colorectal cancer detection in symptomatic patients

et al. 2017

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Prediction models for colorectal cancer (CRC) detection in symptomatic patients, based on easily obtainable variables such as fecal haemoglobin concentration (f-Hb), age and sex, may simplify CRC diagnosis. We developed, and then externally validated, a multivariable prediction model, the FAST Score, with data from five diagnostic test accuracy studies that evaluated quantitative fecal immunochemical tests in symptomatic patients referred for colonoscopy. The diagnostic accuracy of the Score in derivation and validation cohorts was compared statistically with the area under the curve (AUC) and the Chi-square test. 1,572 and 3,976 patients were examined in these cohorts, respectively. For CRC, the odds ratio (OR) of the variables included in the Score were: age (years): 1.03 (95% confidence intervals (CI): 1.02-1.05), male sex: 1.6 (95% CI: 1.1-2.3) and f-Hb (0-<20 µg Hb/g feces): 2.0 (95% CI: 0.7-5.5), (20-<200 µg Hb/g): 16.8 (95% CI: 6.6-42.0), ≥200 µg Hb/g: 65.7 (95% CI: 26.3-164.1). The AUC for CRC detection was 0.88 (95% CI: 0.85-0.90) in the derivation and 0.91 (95% CI: 0.90-093; p = 0.005) in the validation cohort. At the two Score thresholds with 90% (4.50) and 99% (2.12) sensitivity for CRC, the Score had equivalent sensitivity, although the specificity was higher in the validation cohort (p < 0.001). Accordingly, the validation cohort was divided into three groups: high (21.4% of the cohort, positive predictive value-PPV: 21.7%), intermediate (59.8%, PPV: 0.9%) and low (18.8%, PPV: 0.0%) risk for CRC. The FAST Score is an easy to calculate prediction tool, highly accurate for CRC detection in symptomatic patients.

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European panel on the appropriateness of gastrointestinal endoscopy II guidelines help in selecting and prioritizing patients referred to colonoscopy – a quality control study

Cited by 21 publications

References 106 publications

Evidence for overuse of medical services around the world

Evidence for overuse of medical services around the world

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

The fecal hemoglobin concentration, age and sex test score: Development and external validation of a simple prediction tool for colorectal cancer detection in symptomatic patients

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