title: European panel on the appropriateness of gastrointestinal endoscopy II guidelines help in selecting and prioritizing patients referred to colonoscopy--a quality control study.
abstract: OBJECTIVE
  To use information from the referral letters to assess the appropriateness of colonoscopies in a primary open-access referral center, according to the criteria from the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) II, and to compare with the first EPAGE guidelines. Second, to evaluate how the appropriateness and other patient- or doctor-related factors affected the diagnostic yield (DY).
  
  
  METHODS
  A set of variables; symptoms, referring physician and final diagnosis, for 323 referrals accepted for colonoscopy were recorded prospectively and later on assessed using the EPAGE and EPAGE II criteria, respectively. Patients with incomplete visualization of the entire colon or colonoscopic findings as indication were excluded.
  
  
  RESULTS
  EPAGE and EPAGE II criteria were applicable in 287 (95.3%) and 295 (98.0%) referrals, respectively. A total of 166 (57.8%) patients were considered appropriate by EPAGE and 240 (81.4%) patients were considered appropriate by EPAGE II. DY for appropriate versus uncertain/inappropriate referrals was 34.9% versus 17.4% for EPAGE (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.8-4.4, p = 0.003) and 31.3% versus 10.9% for EPAGE II (OR = 3.5, 95% CI: 1.4-8.9, p = 0.007). Sensitivity was higher for EPAGE II (92.6% vs. 73.4%). According to EPAGE II, 68 (23.1%) patients were referred due to lesions identified on other diagnostic procedures, producing a DY of 39.7%. In this group, 70% presented symptoms appropriate for a primary referral to colonoscopy.
  
  
  CONCLUSIONS
  The majority of colonoscopies were found appropriate by EPAGE II. There was a clear association between high appropriateness of the indication and a high DY. EPAGE II is a guideline-improvement that may be useful for both referring physicians and gastroenterologists when considering referrals.
authors.affiliation: Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust , Sandvika , Norway.
authors.forename: Sigrun Losada
authors.initials: SL
authors.lastname: Eskeland
authors.forename: Eirin
authors.initials: E
authors.lastname: Dalén
authors.forename: Jon
authors.initials: J
authors.lastname: Sponheim
authors.forename: Even
authors.initials: E
authors.lastname: Lind
authors.forename: Cathrine
authors.initials: C
authors.lastname: Brunborg
authors.forename: Thomas
authors.initials: T
authors.lastname: de Lange
mesh_terms: D003113:Colonoscopy / Q000592:standards*; D005060:Europe; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards; D011446:Prospective Studies; D011786:Quality Control