Title: Appropriateness in establishing indications for non-therapeutic colonoscopy. Are subjective endoscopist’s and objectivized "European Panel on Appropriateness of Gastrointestinal Endoscopy" assessments equivalent in diagnostic yield?
- Maciej Kohut, Łukasz Liszka, Hubert Bołdys, Tomasz Romańczyk, Grzegorz Rymarczyk, Jacek Pająk
- Original articles
- Polish Gastroenterology
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- gastrointestinal endoscopy, colonoscopy, quality of health care
Introduction: Studies on assessment of colonoscopy appropriateness, according to endoscopists, are scarce. It has been suggested that endosco-pists in their subjective opinions point out more frequently to the necessity of colonoscopy compared to objectivized appropriateness systems.
Aim of study: To assess if there are clinically significant differences in the proportion of patients whose colonoscopies were judged appropriate on the basis of 2 appropriateness evaluation systems: subjective (endoscopist’s individual opinion) and objectivized (elaborated by European Panel on Appropriateness of Gastrointestinal Endoscopy - EPAGE) as well as to assess if the 2 systems are equivalent with regard to sensitivity and specificity to detect clinically significant lesions.
Material and methods: Cross-sectional study was performed on 931 consecutive patients who had been referred for non-therapeutic colonoscopy between June 1st 2003 and November 30th 2004. The clinically significant difference in the proportion of patients judged appropriate or uncertain vs inappropriate as well as in sensitivity and specificity of the 2 systems in detection of significant lesions was set arbitrarily at 10%.
Results: Appropriate or uncertain indications for colonoscopy concerned 90% and 86.3% of patients, according to endoscopists and EPAGE, respectively. Sensitivity of subjective and objectivized systems for detection of significant lesions was 93.9% and 91 %, while specificity 11.4% and 15.4%, respectively.
Conclusions: The percentage of colonoscopies for appropriate/uncertain indications was statistically, but not clinically significantly higher in endoscopist’s assessment than in EPAGE assessment. Equivalence of the 2 systems for the evaluation of appropriateness with regard to diagnostic accuracy was proven.