title: The appropriateness of colonoscopies at a teaching hospital: magnitude, associated factors, and comparison of EPAGE and EPAGE-II criteria.
abstract: BACKGROUND
  The growing demand for colonoscopies and inappropriate colonoscopies have become a significant problem for health care.
  
  
  OBJECTIVE
  To assess the appropriateness of colonoscopies and to analyze the association with some clinical and organizational factors. To compare the results of the European Panel of Appropriateness of Gastrointestinal Endoscopy (EPAGE) and the EPAGE-II criteria.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Endoscopy unit of a teaching hospital in Spain.
  
  
  METHODS
  Patients referred for colonoscopy, excluding urgent, therapeutic indications, and poor cleansing.
  
  
  METHODS
  Appropriateness of colonoscopies according to the EPAGE criteria.
  
  
  RESULTS
  From 749 colonoscopies, 619 were included. Most patients were referred by gastroenterologists (66.1%) in an outpatient setting (80.6%). Hematochezia was the most frequent indication (31.5%) followed by colorectal cancer-related indications (27.3%); a clinically relevant diagnosis was established in 41%. Inappropriate use was higher with EPAGE (27.0%) than EPAGE-II (17.4%) criteria. Surveillance after colonic polypectomy and uncomplicated lower abdominal pain were the indications exhibiting higher inadequacy. Inappropriate use was less with older age, in hospitalized patients, with referrals from internal medicine, and in colonoscopies with clinically relevant diagnoses. Agreement between EPAGE and EPAGE-II was fair (weighted κ = 0.31) but improved to moderate (simple κ = 0.60) after grouping appropriate and uncertain levels.
  
  
  CONCLUSIONS
  The appropriateness criteria are based on panel opinions. Some patients (12%) could not be evaluated with the EPAGE criteria.
  
  
  CONCLUSIONS
  Our study identifies substantial colonoscopy overuse, especially in tumor disease surveillance. The EPAGE-II criteria decrease the inappropriate rate and the possibility of overlooking potentially severe lesions.
authors.affiliation: Servicio de Medicina Digestiva, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Argüello
authors.forename: Virginia
authors.initials: V
authors.lastname: Pertejo
authors.forename: Marta
authors.initials: M
authors.lastname: Ponce
authors.forename: Salvador
authors.initials: S
authors.lastname: Peiró
authors.forename: Vicente
authors.initials: V
authors.lastname: Garrigues
authors.forename: Julio
authors.initials: J
authors.lastname: Ponce
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D003111:Colonic Polyps / Q000175:diagnosis / Q000601:surgery; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D019983:Guideline Adherence; D006784:Hospitals, Teaching / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018571:Sentinel Surveillance; D013030:Spain; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D055815:Young Adult