appropiateness of colonoscopy in the university hospital center of monastir Interest and applicability of criteria established by the European panel on the appropriateness of Gastrointestinal Endoscopy

##plugins.themes.academic_pro.article.sidebar##

Published Apr 3, 2014
Download
pdf
Vol. 92 No. 2 (2014): Issue Feb 2014

##plugins.themes.academic_pro.article.main##

Olfa Hellara
Abir Debbabi
Nabil Ben Chaabene
Wafa Ben Mansour
Hichem Loghmari
Wissem Melki
Fathia Bdioui
Leila Safer
Hammouda Saffar

Abstract

aim : 1) To assess the applicability of EPAGE criteria in there first version (EPAGE I) in clinical practice, 2) to assess colonoscopy appropriateness using EPAGE I criteria, 3) to compare colonoscopy appropriateness and findings.
methods : Four hundred and eighty-seven consecutive diagnostic colonoscopies were included. The appropriateness of the indication of colonoscopy was appreciated using a scoring system on the basis of the EPAGE criteria in there first version (EPAGE I).
results : Appropriateness were applied in 86,4% of the colonoscopies. Fifty-one percent were appropriate, 14% uncertain and 18% inappropriate. The difference of 17% represented the procedures indicated for hematochezia and for witch an appropriateness score can not be attributed because of lack of clinical information. The probability of finding a clinically significant lesion was significantly higher in patients aged ≥50 years, males, inpatients, those referred by gastroenterologists and those who had the colonoscopy for “appropriate” indication according to the EPAGE I criteria. The independent variables correlated with the diagnostic yield of colonoscopy were the age, the appropriateness of indication and the health care setting.
Conclusion : EPAGE I criteria were applicable in most patients and were correlated with significant findings. They are thereby useful to rationalize colonoscopy demand. However, they could be regularly updated.

Keywords:

Colonoscopy, Indications, expert panel, Appropriateness, EPAGE, Diagnostic yield.

##plugins.themes.academic_pro.article.details##

References

  1. Kmieciak Le Corguillé M, Gaudric M , Roche H, Brezault C, Dieumegard B et al : Pertinence des indications de la coloscopie dans un service de gastroentérologie de l'AP-HP en 2001. Application de critères établis par un panel d'experts européens. Gastroenterol Clin Biol 2003;27:213-218.
  2. Terraz O, Wietlisbach V, Jeannot JG ,Bumand B, Froehlich F, Gonvers JJ et al. The EPAGE internet guideline as a decision tool for determining the appropriateness of colonoscopy. Digestion 2005; 71: 72-77.
  3. Letonturier R, Debourse J, Thillière F ,Combes R, Vader JP, Bumand B et al. Evaluer la spécificité d'un centre hospitalouniversitaire: Exemple du recours à la colonoscopie (enquête EPAGE). Press Med 2004 ; 33 : 241-6.
  4. Vader JP, Pache I, Froehlich F , Bumand B, Schnider C, Dubois RW et al. Overuse and underuse of colonoscopy in a European primary care setting. Gastrointest Endosc 2000; 52:593-9.
  5. Denis B, Weiss AM, Peter A, Bottlaender J, Chiappa P. Quality assurance and gastrointestinal endoscopy: an audit of 500 colonoscopic procedures. Gastroenterol Clin Biol 2004; 28:1245- 1255.
  6. Grasset D, Morfoisse JJ, Seigneuric C et l'Association Nationale des Gastroentérologues des Hôpitaux non universitaires (ANGH). Conditions de réalisation et résultats des coloscopies réalisées dans les hôpitaux non universitaires : Résultats d'une enquête transversale multicentrique de l'ANGH. Gastroenterol Clin Biol 2000; 24 : 273-278.
  7. Burnand B, Harris JK, Wietlisbach V ,Froehlich F, Vader JP, Gonvers JJ et al: Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE): Gastrointest Endosc 2006; 63:1018-26.
  8. Chan Th et Goh Kl : Appropriateness of colonoscopy using the ASGE guidelines: experience in a large Asian hospital: Chinese Journal of Digestive Diseases 2006; 7; 24-32.
  9. Balaguer F, Llach J, Castells A , Bordas JM, Ppellise M, Rodriguez-Moranta F et al. The European panel on the appropriateness of gastrointestinal endoscopy guidelines colonoscopy in an open-access endoscopy unit: a prospective study. Aliment Pharmacol Ther 2005; 21: 609-613.
  10. Buyse S, Nahon S, Lahmek P, Lesgourgues B, Tuszynski T, Taissac L et al : Pertinence des indications de la coloscopie chez 1 226 patients âgés de moins de 40 ans. Gastroentérol Clin Biol 2003; 27, HS1, 0399-8320.
  11. Bersani G, Rossi A, Ricci G, Pollino V, De Fabritiis G, Suzzi A et al : Do ASGE guidelines for the appropriate use of colonoscopy enhance the probability of finding relevant pathologies in an open access service?: Digestive and Liver Disease 2005;37: 609-614.
  12. Morini S, Hassan C, Meucci G, Toldi A, Zullo A, Minoli G: Diagnostic yield of open access colonoscopy according to appropriateness. Gastrointest Endosc 2001; 54:175-9.
  13. Siddique I, Mohan K, Hasan F, Memon A, Patty I, Al-Nakib B: Appropriateness of indication and diagnostic yield of colonoscopy: First report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy. World J Gastroenterol 2005; 11:7007-7003.
  14. De Bosset V, Froehlich F, Rey JP,Thorens J, Schneider C, Wietlisbach V et al. Do explicit appropriateness criteria enhance the diagnostic yield of colonoscopy? Endoscopy 2002; 34: 360- 368.
  15. Grassini M, Verna C, Niola P, Navino M, Battaglia E, Bassotti G: Appropriateness of colonoscopy: Diagnostic yield and safety in guidelines. World J Gastroenterol 2007; 13: 1816-1819.
  16. Froehlich F, Pache I, Burnand B, Vader JP, Fried M, Beglinger C et al. Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: a prospective study. Gastrointest Endosc 1998; 48:128-36.
  17. Gimeno Garcia AZ, Gonzalez Y, Nicolà s-Pérez D, Adrian Z, Romero R, Alarcon Fernandez O et al. Clinical validation of the European Panel on the Appropriateness of Gastroentestinal Endoscopy (EPAGE) II criteria in an open-access unit: a prospective study. Encocopy 2012;44:32-7.
  18. Arguello L, Pertejo V, Ponce M, Salvador P, Garrigues V, Ponce J. The appropriateness of colonoscopies at a teaching hospital: magnitude, associated factors, and comparison of EPAGE and EPAGE-II criteria. Gastrointestinal Endoscopy 2012;75:138-45.