title: A cross-sectional study of the appropriateness of colonoscopy requests in the Spanish region of Catalonia.
abstract: BACKGROUND
  Colonoscopies are being requested with increasing frequency in the last few years, as they are used both as a diagnostic and therapeutic procedure in several gastrointestinal diseases. Our purpose is to describe the appropriateness of colonoscopy requests issued both from primary care centres and from hospitals, according to the EPAGE II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy).
  
  
  METHODS
  Cross-sectional study. Colonoscopy requests issued since January 2011 and received at the endoscopy units of all six reference hospitals serving the primary care centres of the South Metropolitan and Central Catalonia districts will be collected (total=1500 requests). Variables to be collected include gender, date of birth, origin of the request and reference hospital, priority of the procedure, type of clinician requesting the procedure, date and indication of request, abdominal examination performed, anal inspection examination performed, date of last colonoscopy if applicable, diagnosis and date of diagnosis. Using the available information and the EPAGE II website, colonoscopy requests will be assigned as an appropriateness score. The association between the variables collected and the EPAGE II scores will be assessed using a Student's t test and a χ(2) test. A multilevel logistic model will be generated on the factors associated with the appropriateness of the requests.
  
  
  BACKGROUND
  Colonoscopy is a costly procedure and not free from complications. In order to increase cost effectiveness, reduce waiting lists and optimise resources, it is necessary to use tools such as the EPAGE II guidelines, which establish criteria to assess the appropriateness of colonoscopies. The purpose of this study is to describe the current situation and to discuss whether current clinical practice is appropriate. The results of the study will be published in the next few years. In consideration of the ethical principles and methods of the research study, approval was granted for the project.
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona,  Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Puente
authors.forename: Francesc Xavier
authors.initials: FX
authors.lastname: Cantero
authors.forename: Maria
authors.initials: M
authors.lastname: Llagostera
authors.forename: Pilar
authors.initials: P
authors.lastname: Piñeiro
authors.forename: Raquel
authors.initials: R
authors.lastname: Nieto
authors.forename: Rosa
authors.initials: R
authors.lastname: Saladich
authors.forename: Juanjo
authors.initials: J
authors.lastname: Mascort
authors.forename: Mercè
authors.initials: M
authors.lastname: Marzo
authors.forename: Jesús
authors.initials: J
authors.lastname: Almeda
authors.forename: Manel
authors.initials: M
authors.lastname: Segarra