title: Use of colonoscopy in the management of patients with Crohn's disease: appropriateness and diagnostic yield.
abstract: BACKGROUND
  Colonoscopy is a necessary tool in the management of Crohn's disease, but the benefit achieved by the procedure is a matter of debate. In the present study we evaluate the clinical impact of performing colonoscopy in Crohn's disease patients.
  
  
  METHODS
  Consecutive patients with Crohn's disease undergoing colonoscopy were considered. The following issues were considered: appropriateness of indications; relevant findings able to change the management of the patients; the endoscopist's management decisions based on patient's clinical picture, i.e. increased, maintained or decreased treatment, compared with those selected after performing endoscopy.
  
  
  RESULTS
  204 patients (116 male/88 female, mean age 41 years) were included. Colonoscopy was judged indicated in 52.9% cases, according to current guidelines. In 54% of patients, endoscopy revealed a significant lesion, and this rate was significantly lower for non-indicated procedures (25.9%, p<0.0001). The endoscopic findings were in disagreement with symptoms in about 25% of cases, but the impact of the endoscopic findings on the endoscopist's decision was likely to be very small without any differences between appropriate and inappropriate procedures.
  
  
  CONCLUSIONS
  Endoscopy is a potent tool in the management of Crohn's disease, if correctly used, but in the majority of cases a correct therapeutic decision may be established simply on the basis of clinical picture and non-invasive markers, whilst relevant endoscopic findings have a relatively low impact on the medical treatment.
authors.affiliation: Department of Gastroenterology, L. Sacco University Hospital, Via G. B. Grassi 74, 20157 Milan, Italy. gimanes@tin.it
authors.forename: G
authors.initials: G
authors.lastname: Manes
authors.forename: V
authors.initials: V
authors.lastname: Imbesi
authors.forename: S
authors.initials: S
authors.lastname: Ardizzone
authors.forename: A
authors.initials: A
authors.lastname: Cassinotti
authors.forename: M
authors.initials: M
authors.lastname: Bosani
authors.forename: A
authors.initials: A
authors.lastname: Massari
authors.forename: G
authors.initials: G
authors.lastname: Bianchi Porro
mesh_terms: D000328:Adult; D003113:Colonoscopy; D003424:Crohn Disease / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male