Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: a prospective study

Froehlich, Florian; Pache, Isabelle; Burnand, Bernard; Vader, J.-P.; Fried, Michael; Beglinger, Christoph; Stalder, G; Gyr, K.; Thorens, Joël; Schneider, Catherine; Kosecoff, Jacqueline; Kolodny, Marvin; Dubois, Robert W.; Gonvers, Jean‐Jacques; Brook, Robert H.

doi:10.1016/s0016-5107(98)70153-1

Cited by 51 publications

(46 citation statements)

References 26 publications

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“…This has led to long waiting lists and unavoidable economic consequences on the management of the Health Care System, which is experiencing a very severe cost crisis in Italy. Thus, the appropriateness of colonoscopy performance can reduce overuse, improve quality of care and decrease costs [5] , especially in those countries where the digestive endoscopic services function on an open access system basis. Defining strong criteria for the appropriateness of endoscopic procedures is therefore needed to face the health care demand of the population and the government to reduce costs.…”

Section: Discussionmentioning

confidence: 99%

“…To maintain or enhance the quality of care in an increasingly cost-conscious environment, the ability to determine appropriateness of the care may be essential [4] . Appropriateness of procedures, such as colonoscopy, is defined by the fact that the health benefit exceeds the health risk by a sufficiently wide margin of security [5] . To define the correct use of GI lower endoscopy, the American Society for Gastrointestinal Endoscopy (ASGE) has developed indication criteria for diagnostic endoscopic procedures [6] .…”

Section: Introductionmentioning

confidence: 99%

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Appropriateness of colonoscopy: Diagnostic yield and safety in guidelines

Grassini

Verna²,

Niola³

et al. 2007

WJG

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AIM:To evaluate if the guidelines for the appropriateness of performing colonoscopy by American Society for Gastrointestinal Endoscopy (AGSE) and Italian Society of Digestive Endoscopy (SIED) yield a good diagnostic efficacy and do not present risks of missing important colonic pathologies in an Italian population sample. METHODS:A total of 1017 consecutive patients (560 men and 457 women; mean age 64.4 ± 16 years) referred to an open-access endoscopy unit for colonoscopy from July 2004 to May 2006 were evaluated according to ASGE and SIED guidelines for appropriateness of performing the procedure. Diagnostic yield was defined as the percentage of relevant colonic pathologies of the total number of colonoscopies performed.RESULTS: About 85.2% patients underwent colonoscopy that was considered appropriate based on at least one ASGE or SIED criterion, while it was considered inappropriate for 14.8% of patients. The diagnostic yield of colonoscopy was significantly higher for appropriate colonoscopies (26.94% vs 10.6%, P < 0.001) than for inappropriate colonoscopies (5.3%). There was no missed colorectal cancer following the ASGE/SIED criteria.CONCLUSION: ASGE/SIED guidelines have shown a good diagnostic yield and the rate of missing relevant colonic pathologies seems very low. Unfortunately, the percentage of inappropriate referrals for colonoscopy in an open-access endoscopy system is still high, despite the number of papers published on the issue and the definition of international guidelines. Further steps are required to update and standardize the guidelines to increase their diffusion and to promote educational programs for general practitioners.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Appropriateness of colonoscopy: Diagnostic yield and safety in guidelines

Grassini

Verna²,

Niola³

et al. 2007

WJG

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“…Concordance between the practicing physicians and the expert panel about the rating of the appropriateness of a procedure has been the topic of previous research [24], which showed that there can be areas of disagreement. This raises the question of potential erroneous perception (in terms of under- or overestimation) specialist clinicians may have of the appropriateness of the procedure they perform [25,26,27,28,29]. It has been estimated that 2.4 million colonoscopies were performed in 1996 in the USA [30], and previous research has noted both overuse and underuse of colonoscopy depending on the clinical indication [18].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2005

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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.

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“…[11] The diagnostic yield of an endoscopic procedure is defined as its capacity for identifying a lesion that is potentially important to patient care and has been reported in relation to the appropriateness of the indication. [12] For colonoscopy, the diagnostic yield ranges between 40% to 45% for procedures that are referred for appropriate indications and 15 -20% for those with inappropriate indications. [11][12][13] However, in the only randomized controlled trial on the use of urgent colonoscopy for evaluation of acute PR bleeding, 42% of patients had a definite diagnosis made when colonoscopy was performed within 8 hours of admission.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Yield of Colonoscopy in Patients Presenting with Per Rectum Bleeding at a Tertiary Care Centre

2017

IJSR

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Background & Objective: Per rectal (PR) bleeding is a common reason for hospitalization and is defined as bleeding thatemanates from a source distal to the ligament of Treitz. Although bleeding ceases spontaneously in 80% cases, 25% risk of re-bleed persists along with a difficulty of identifying the bleeding source. The purpose of this paper was to investigate the diagnostic yield of colonoscopy and assess the detection rate of different lesions in patients with PR bleeding as seen in our hospital. Methods: Fifty adult patients with PR bleed, irrespective of their gender were selected from general medical OPD and general medical wards. All patients were subjected to fibre-optic colonoscopy after necessary preparation and findings were recorded. Biopsies taken from suspected lesions were clinically indicated. Results: Study population included 50 patients, 28 males (56%) and 22 females (44%) with a mean age of 47.16±18.08 years. Findings at colonoscopy were; hemorrhoids (48%), polyp (6%), growth (6%), diverticular disease (6%), ulceration (4%), fissure (2%), fistula (2%), inflammatory bowel disease i.e., IBD (2%) and telangiectasia (2%). Normal findings were reported in 22% cases. Conclusion: Colonoscopy has very high diagnostic yield and would be recommended in the workup of patients presenting with bleeding per rectum.

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Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: a prospective study

Cited by 51 publications

References 26 publications

Appropriateness of colonoscopy: Diagnostic yield and safety in guidelines

Appropriateness of colonoscopy: Diagnostic yield and safety in guidelines

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

Diagnostic Yield of Colonoscopy in Patients Presenting with Per Rectum Bleeding at a Tertiary Care Centre

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