Do Explicit Appropriateness Criteria Enhance the Diagnostic Yield of Colonoscopy?

Abstract

The use of detailed and explicit appropriateness criteria for colonoscopy significantly enhances the identification of relevant lesions and in particular of colon cancer. The use of such criteria could therefore improve patient selection for colonoscopy and thus contribute to efforts aimed at enhancing the quality and efficiency of care.

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)

“…In the study of Chan et al, only indication of rectal bleeding in multivariate analysis was predictive for colonic lesions. The fact that gastroenterologist [20,23], male sex [15,31], exploration of iron deficiency anemia [14] or rectal bleeding [24] and older age of patients [16,31] were factors associated with colonic lesion was also found in several studies. Colonic functional disorders was, in absence of signs of severity (weight loss, anemia, rectal bleeding, nocturnal recurdescence of signs and family history of colorectal cancer) associated to a low diagnosis yield of colonoscopy according to Schüssele et al [30].…”

“…Carrion et al based on the EPAGE II criteria had also reported 94% of applicability [14]. Bosset et al with a Swiss criteria noted applicability of 96% [15]. However, Fernández-Esparrach et al had observed a rather smaller proportion (80%) applicable indication with the EPAGE II criteria [16].…”

“…Siddique [20] Bersani [28] and Morini [29] were reported respectively 20%, 37% and 29% of inappropriate colonoscopy on ASGE criteria. A study relied on the criteria of a Swiss panel found from Bosset et al 13% of inappropriate colonoscopy [15]. Several factors have been identified in these studies, as influencing the proportion of inappropriate indication in their studies.…”

Editorials

“…Duration of protection against disease and carriage are important in estimating how many cases can be prevented and thus the potential cost-effectiveness of the vaccine. The impact of such vaccines in high income countries may have resulted more from the excellent direct and herd protection amongst adolescents and young adults than from the short duration responses induced by the vaccination of young children [8]. The reasons for these age-dependent differences in immunity are not completely understood but may relate to developmental differences in the immune system, or be driven by environmental factors.…”

“…Generally, bactericidal titers of ≥1:4 in human serum are considered protective against IMD [7]. Titers as high as 1:128 in rabbit serum are needed to assure that a titer of 1:4 are present, if measured with human serum [8]. Despite this shortcoming, the results of this bridging study are adequately reassuring regarding efficacy and safety of this vaccine in the Indian context.…”