ASGE and EPAGE guidelines are an important help to select and prioritise patients referred to colonoscopy.
Eirin Schille1 , Jon Sponheim2 , Harald Torsvik2, Even Lind2, Øyvind Dyrhaug2, Jon Michael Gran3, Thomas de Lange2.
1 University of Oslo, Faculty of Medicine, Oslo, Norway2 Asker and Bærum Hospital, Medical department, Rud, Norway3 University of Oslo, Institute of Biomedical statistics, Oslo, Norway
Background: This prospective study examined the relationship between the appropriate use of colonoscopy postulated in the American Society for Gastrointestinal Endoscopy 2000 (ASGE) guidelines and in the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) guidelines and diagnostic yield.
Methods: 323 consecutive patients referred to colonoscopy were assessed to have appropriate or inappropriate indications for colonoscopy according to ASGE and EPAGE guidelines. Referrals labelled ”generally indicated” by ASGE were compared with referrals labelled ”necessary”, ”appropriate”, or ”uncertain” by EPAGE. Referrals labelled ”generally not indicated” and ” generally contraindicataed” by ASGE were compared with referrals labelled ”inappropriate” by EPAGE. Diagnostic yield was given by appropriateness and significant endoscopic diagnoses.
Results: The rate of ”apppropriate” colonoscopies was 78 % for both ASGE and EPAGE, while the rates of ”inappropriate” colonoscopies were 13 % and 19 % for ASGE and EPAGE, respectively. All referrals ending up with a colorectal cancer diagnosis were labelled ”appropriate”. The two guidelines disagreed on the labelling of a total of 22 % of the referrals. 29 % of the referrals ended up with a significant diagnosis. The diagnostic yield for ASGE and EPAGE when the referrals were labelled ”appropriate” was 34 %. When labelled ”inappropriate”, the diagnostic yield for ASGE and EPAGE was; 9 % and 8 % (p = 0.001) and (p < 0.001), respectively. ASGE´s odds ratio of having an endoscopic diagnosis when labelled ”appropriate” compared to ”inappropriate” was 4.9 %, CI (1.7, 14.2) (p = 0.001). EPAGE´s odds ratio was 5.8 with a 95 % CI (2.2, 15.0) (p < 0.0001).
Conclusion: Applying a referral guideline for colonoscopy will increase the probability of finding a significant endoscopic diagnosis. The guidelines can be a handy tool for the general practitioner in referring appropriate patients for colonoscopy and at the same time administer the endoscopist´s prioritisation of referrals. The guidelines are limitied by the patient´s presenting symptoms and clinical findings and demonstrate no absolute correlation to a significant diagnosis.