The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE): Project and Methods

Vader, J.-P.; Burnand, Bernard; Froehlich, Florian; Dubois, Robert W.; Bochud, Murielle; Gonvers, Jean‐Jacques

doi:10.1055/s-1999-71

Cited by 57 publications

(52 citation statements)

References 30 publications

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“…Based upon the literature review and the initial contact with experts, factors that contribute to the appropriateness of various types of treatment for differing presentations of CD were identified using a process similar to previous work by our group [12, 13]. These factors were expanded into detailed indications (scenarios describing patient, disease and treatment characteristics) which differ from one another according to these factors.…”

Section: Methodsmentioning

confidence: 99%

Appropriate Treatment for Crohn’s Disease: Methodology and Summary Results of a Multidisciplinary International Expert Panel Approach – EPACT

et al. 2006

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Background/Aims: For many therapeutic decisions in Crohn’s disease (CD), high-grade evidence is lacking. To assist clinical decision-making, explicit panel-based appropriateness criteria were developed by an international, multidisciplinary expert panel. Methods: 10 gastroenterologists, 3 surgeons and 2 general practitioners from 12 European countries assessed the appropriateness of therapy for CD using the RAND Appropriateness Method. Their assessment was based on the study of a recent literature review of the subject, combined with their own expert clinical judgment. Panelists rated clinical indications and treatment options using a 9-point scale (1 = extremely inappropriate; 9 = extremely appropriate). These scenarios were then discussed in detail at the panel meeting and re-rated. Median ratings and disagreement were used to aggregate ratings into three assessment categories: appropriate (A), uncertain (U) and inappropriate (I). Results: 569 specific indications were rated, dealing with 9 clinical presentations: mild/moderate luminal CD (n = 104), severe CD (n = 126), steroid-dependent CD (n = 25), steroid-refractory CD (n = 37), fistulizing CD (n = 49), fibrostenotic CD (n = 35), maintenance of medical remission of CD (n = 84), maintenance of surgical remission (n = 78), drug safety in pregnancy (n = 24) and use of infliximab (n = 7). Overall, 146 indications (26%) were judged appropriate, 129 (23%) uncertain and 294 (52%) inappropriate. Frank disagreement was low (14% overall) with the greatest disagreement (54% of scenarios) being observed for treatment of steroid-refractory disease. Conclusions: Detailed explicit appropriateness criteria for the appropriate use of therapy for CD were developed for the first time by a European expert panel. Disease location, severity and previous treatments were the main factors taken into account. User-friendly access to EPACT criteria is available via an Internet site, www.epact.ch, allowing prospective evaluation and improvement of appropriateness of current CD therapy.

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Section: Methodsmentioning

confidence: 99%

Appropriate Treatment for Crohn’s Disease: Methodology and Summary Results of a Multidisciplinary International Expert Panel Approach – EPACT

et al. 2006

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“…The guideline for the appropriateness of colonoscopy used in this study was developed by the EPAGE using the RAND method [14,15,16]. The RAND method is one of the most widely accepted methods of determining appropriateness of care [17].…”

Section: Methodsmentioning

confidence: 99%

“…It combines scientific evidence with systematically elicited and quantified expert opinion about the appropriateness of care. The members of the multidisciplinary international expert panel examined existing evidence summarized in a comprehensive literature review and rated the appropriateness of all possible indications for colonoscopy on a nine-point scale (1–3 inappropriate; 4–6 uncertain; 7–9 appropriate) [16]. A colonoscopy was considered appropriate if the expected health benefits outweighed the expected negative consequences by a sufficiently wide margin that the procedure was worth doing [14, 18].…”

Section: Methodsmentioning

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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“…This applies to the perfor-mance of the procedure and the appropriateness of the indications [1][2][3][4][5][6][7][8][9][10][11][12].…”

Section: Quality Controlmentioning

confidence: 99%

Appropriateness of Diagnostic Digestive Endoscopy

Lambert

Rey²

2002

Dig Dis

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The indications of diagnostic endoscopy – upper gastrointestinal endoscopy or colonoscopy – in the exploration of the digestive tract are classified as appropriate or inappropriate with regard to criteria established in guidelines supported by national scientific societies and by insurance companies. This applies to the exploration of symptomatic patients and to screening protocols for malignant lesions. Functional or nonstructural diseases being more frequent than structural diseases, negative findings in endoscopy are common. However this reassures the patient and should not be considered as overuse. On the other hand excess in the repetition of negative endoscopic procedures during surveillance raises ethical problems, increased costs, and may be considered as unethical.

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The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE): Project and Methods

Cited by 57 publications

References 30 publications

Appropriate Treatment for Crohn’s Disease: Methodology and Summary Results of a Multidisciplinary International Expert Panel Approach – EPACT

Appropriate Treatment for Crohn’s Disease: Methodology and Summary Results of a Multidisciplinary International Expert Panel Approach – EPACT

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

Appropriateness of Diagnostic Digestive Endoscopy

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