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

Abstract

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.

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

“…The high degree of appropriateness of colonoscopy detected in this thesis is supported by both previous (125,128,131) and recent studies (126,204). This largely reflects the EPAGE II guidelines' lowered threshold for classifying colonoscopies as appropriate.…”

“…The overall diagnostic yield in the present study is also in agreement with similar previous studies, ranging between 25-41% (125,128,131). A more recent publication show a much higher diagnostic yield (51%) (204). However, in that study diverticular disease was included as a significant finding.…”

“…Diverticular disease is a frequent finding in patients after the age of 50 years (210) and in paper I we consider this a normal finding. The diagnostic yield was found to be higher in appropriate referrals compared with inappropriate referral in several studies (125,128,131,204), and advanced neoplastic lesions are rarely found in colonoscopies classified as inappropriate (125,128,131,204).…”

Observational study of appropriateness of colonoscopy using appropriateness criteria designed by EPAGE

“…Most conditions that affect the lower gastrointestinal tract can be diagnosed by colonoscopy, and some therapeutic procedures may be performed simultaneously. 2 "Appropriateness was defined to mean that the expected health benefit exceeds the expected negative consequences (risks) by a sufficiently wide margin that gastroscopy or colonoscopy, respectively, is worth performing." 3 A colonoscopy was defined as being appropriate if the expected health benefits outweighed the expected negative consequences by a sufficiently wide margin that the procedure was worth doing.…”

Atención primaria y detección del cáncer colorrectal

“…A la vez, y aunque se desconoce con exactitud, la tasa de progresión de adenoma avanzado a CCR se estima que es baja y oscila en torno al 4% anual 7 . En este contexto es fundamental optimizar la adecuación y asegurar la calidad de todas las colonoscopia, se realicen o no en el contexto de un programa de cribado, y dirigir la vigilancia a aquellos pacientes que realmente se beneficien de ella, con la mínima frecuencia necesaria para lograr el mayor rendimiento preventivo del CCR, limitando el número de exploraciones de eficacia dudosa y reduciendo el riesgo de las complicaciones asociadas 8 .…”