title: The appropriateness of colonoscopy: a multi-center, international, observational study.
abstract: OBJECTIVE
  To examine the appropriateness and necessity of colonoscopy across Europe.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  A total of 21 gastrointestinal centers from 11 countries.
  
  
  METHODS
  Consecutive patients referred for colonoscopy at each center.
  
  
  METHODS
  Appropriateness criteria developed by the European Panel on the Appropriateness of Gastrointestinal Endoscopy, using the RAND appropriateness method, were used to assess the appropriateness of colonoscopy.
  
  
  METHODS
  Appropriateness of colonoscopy.
  
  
  RESULTS
  A total of 5213 of 6004 (86.8%) patients who underwent diagnostic colonoscopy and had an appropriateness rating were included in this study. According to the criteria, 20, 26, 27, or 27% of colonoscopies were judged to be necessary, appropriate, uncertain, or inappropriate, respectively. Older patients and those with a major illness were more likely to have an appropriate or necessary indication for colonoscopy as compared to healthy patients or patients who were 45-54 years old. As compared to screening patients, patients who underwent colonoscopy for iron-deficiency anemia [OR: 30.84, 95% CI: 19.79-48.06] or change in bowel habits [OR: 3.69, 95% CI: 2.74-4.96] were more likely to have an appropriate or necessary indication, whereas patients who underwent colonoscopy for abdominal pain [OR: 0.64, 95% CI: 0.49-0.83] or chronic diarrhea [OR: 0.54, 95% CI: 0.40-0.75] were less likely to have an appropriate or necessary indication.
  
  
  CONCLUSIONS
  This study identified significant proportions of inappropriate colonoscopies. Prospective use of the criteria by physicians referring for or performing colonoscopies may improve appropriateness and quality of care, especially in younger patients and in patients with nonspecific symptoms.
authors.affiliation: Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: J K
authors.initials: JK
authors.lastname: Harris
authors.forename: F
authors.initials: F
authors.lastname: Froehlich
authors.forename: J-J
authors.initials: JJ
authors.lastname: Gonvers
authors.forename: V
authors.initials: V
authors.lastname: Wietlisbach
authors.forename: B
authors.initials: B
authors.lastname: Burnand
authors.forename: J-P
authors.initials: JP
authors.lastname: Vader
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000592:standards*; D005060:Europe; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies