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European gastrointestinal endoscopy guidelines to help select patients for colonoscopy

The latest issue of the Scandanavian Journal of Gastroenterology investigates the appropriateness of the European gastrointestinal endoscopy guidelines in selecting and prioritizing patients referred to colonoscopy.

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Dr Sigrun Losada Eskeland and colleagues used 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.

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.

70% presented symptoms appropriate for a primary referral to colonoscopy
Scandanavian Journal of Gastroenterology

The team found that EPAGE and EPAGE II criteria were applicable in 95%, and 98% of referrals, respectively.

A total of 58% of patients were considered appropriate by EPAGE, and 81% of patients were considered appropriate by EPAGE II.

The researchers noted that the diagnostic yield for appropriate versus uncertain/inappropriate referrals was 35% versus 17% for EPAGE, and 31% versus 11% for EPAGE II.

The research team found that sensitivity was higher for EPAGE II.

According to EPAGE II, 23% of patients were referred due to lesions identified on other diagnostic procedures, producing a diagnostic yield of 40%.

In this group, 70% presented symptoms appropriate for a primary referral to colonoscopy.

Dr Eskeland's team concludes, "The majority of colonoscopies were found appropriate by EPAGE II."

"There was a clear association between high appropriateness of the indication and a high diagnostic yield."

"EPAGE II is a guideline-improvement that may be useful for both referring physicians and gastroenterologists when considering referrals."

Scand J Gastroenterol 2014: 49(4): 492-500
22 April 2014

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