Appropriateness of colonoscopy in a digestive endoscopy unit: a prospective study using ASGE guidelines.
OBJECTIVE
Appropriate indications for colonoscopy (C) are essential for a rational use of resources. The aim of this study is to evaluate the appropriateness of indication for C according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines and to evaluate whether appropriate use was correlated with the diagnostic yield of C.


METHODS
We analysed 677 consecutive C performed over an 11-month period in a digestive endoscopy unit with an open access system.


RESULTS
The rate of 'generally indicated' C was 77% and 'generally not indicated' C was 18%. The rate of indication not listed in the ASGE guidelines was 5%. The percentage of generally not indicated C requested by gastroenterologists for outpatients was lower than that requested by primary care surgeons or doctors (9.5%, 29%, 25.3%, respectively). In 38 (7.3%) and in 111 (21.3%) of 520 patients with appropriate C, cancer and polyps larger than 5 mm were found, respectively. Twenty polyps greater than 5 mm were detected in 15 cases (12%) of 122 inappropriate C, with only one case of intramucosal carcinoma; four (12%) polyps measuring over 5 mm were found in C not listed in ASGE guidelines. No advanced stage cancer was detected in the inappropriate group and in C not listed in ASGE guidelines.


CONCLUSIONS
Our results showed the high rate of inappropriate procedures, according to ASGE guidelines, requested by surgeons, internists and primary care doctors for both outpatients and inpatients. The proportion of not indicated endoscopic procedures requested by gastroenterologists must be reduced through more carefully application of ASGE guidelines. Endoscopic findings were more stringent in appropriate C.
Suriani
Renzo
R
Department of Gastroenterology, Ospedale degli Infermi, Rivoli, Italy.
Rizzetto
Mario
M
Mazzucco
Dario
D
Grosso
Silvia
S
Gastaldi
Paola
P
Marino
Maria
M
Sanseverinati
Sabina
S
Venturini
Ivo
I
Borghi
Athos
A
Zeneroli
Maria Luisa
ML
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000592:standards*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D019564:Unnecessary Procedures; D055815:Young Adult