Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE).
BACKGROUND
Screening for colorectal cancer (CRC) has been shown to decrease mortality.


OBJECTIVE
To examine determinants associated with having (1) a screening colonoscopy, (2) an appropriate indication for screening, and (3) a significant diagnosis at screening.


METHODS
Prospective observational study.


METHODS
Twenty-one endoscopy centers from 11 countries.


METHODS
Asymptomatic patients who underwent a colonoscopy for the purpose of detecting CRC and who did not have a history of polyps or CRC, a lesion observed at a recent barium enema or sigmoidoscopy, or a recent positive fecal occult blood test.


METHODS
Screening colonoscopy.


METHODS
Appropriateness according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria and significant diagnoses (cancer, adenomatous polyps, new diagnoses of inflammatory bowel disease, angiodysplasia).


RESULTS
Of 5069 colonoscopies, 561 (11%) were performed for screening purposes. Patients were more likely to have a screening colonoscopy if they were aged 45 to 54 years (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.60-3.99). Screening colonoscopies were appropriate, uncertain, and inappropriate in 26%, 60%, and 14% of cases, respectively. Eighty-one significant diagnoses were made, including 4 cancers. Significant diagnoses were more often made for uncertain/appropriate indications (OR 3.20, 95% CI 1.12-9.17) than for inappropriate indications.


CONCLUSIONS
Although data completeness was asked of all centers, it is possible that not all consecutive patients were included. Participating centers were a convenience sample and thus may not be representative.


CONCLUSIONS
About 1 of 10 colonoscopies were performed for screening, preferentially in middle-aged individuals. A higher diagnostic yield in uncertain/appropriate indications suggests that the use of appropriateness criteria may enhance the efficient use of colonoscopy for screening.
Burnand
Bernard
B
Institut Universitaire de Médecine Sociale et Préventive, Rue du Bugnon 17, CH-1005 Lausanne, Switzerland.
Harris
Jennifer K
JK
Wietlisbach
Vincent
V
Froehlich
Florian
F
Vader
John-Paul
JP
Gonvers
Jean-Jacques
JJ
D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio