Abstract
BACKGROUND: The appropriate selection of patients for colonoscopy is crucial for an efficient use of endoscopy. The role of endoscopist in filtering out inappropriate referrals is largely unknown. METHODS: A multicentre, prospective study was performed in which consecutive patients referred for colonoscopy during a 1-month period were enrolled. Before colonoscopy, the endoscopist assessed appropriateness of the endoscopic referral without directly consulting official guidelines, also collecting clinical and demographic variables. Appropriateness of the indication was eventually assessed by a group of experts based on the American Society for Gastrointestinal Endoscopy guidelines, representing the gold standard. Outcomes of the study were the inappropriateness rate and the main related causes, as well as the concordance rate between the endoscopists and the experts. A multivariate analysis was performed to identify predictors of inappropriateness. RESULTS: One thousand seven hundred ninety-nine patients were enrolled in 20 centres, of which 1489 outpatients were included in the final analysis. According to the American Society for Gastrointestinal Endoscopy guidelines, 432 referrals were inappropriate, corresponding to an inappropriateness rate of 29%. At multivariate analysis, prescription of a repeated colonoscopy (≥2 colonoscopies in the same patient) was strongly associated with the inappropriateness of the indication (odds ratio: 8.8; 95% confidence interval: 6.2, 12.7). Postpolypectomy or post-colorectal cancer surveillance accounted for 77% of the inappropriate control procedures. A 79% concordance rate between endoscopist and expert assessment was found. Among the 317 discordant cases, postpolypectomy or post-colorectal cancer surveillance accounted for 51% of the cases, the endoscopists mistakenly classifying it as appropriate in 55% to 61% of the inappropriate cases. CONCLUSIONS: Inappropriateness in outpatient colonoscopy referrals remains high, surveillance procedures representing the most frequent source of inappropriateness.
| Original language | English |
|---|---|
| Pages (from-to) | 590-594 |
| Number of pages | 5 |
| Journal | Journal of Clinical Gastroenterology |
| Volume | 46 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - Aug 2012 |
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Keywords
- appropriateness
- colonoscopy
- indication
ASJC Scopus subject areas
- Gastroenterology
Cite this
Appropriateness of the indication for colonoscopy : Is the endoscopist the 'gold standard'? / Petruzziello, Lucio; Hassan, Cesare; Alvaro, Domenico; Kohn, Anna; Rossi, Zaccaria; Zullo, Angelo; Cesaro, Paola; Annibale, Bruno; Barca, Alessandra; Di Giulio, Emilio; Rossi, Paolo Giorgi; Grasso, Enrico; Ridola, Lorenzo; Spada, Cristiano; Costamagna, Guido.
In: Journal of Clinical Gastroenterology, Vol. 46, No. 7, 08.2012, p. 590-594.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Appropriateness of the indication for colonoscopy
T2 - Is the endoscopist the 'gold standard'?
AU - Petruzziello, Lucio
AU - Hassan, Cesare
AU - Alvaro, Domenico
AU - Kohn, Anna
AU - Rossi, Zaccaria
AU - Zullo, Angelo
AU - Cesaro, Paola
AU - Annibale, Bruno
AU - Barca, Alessandra
AU - Di Giulio, Emilio
AU - Rossi, Paolo Giorgi
AU - Grasso, Enrico
AU - Ridola, Lorenzo
AU - Spada, Cristiano
AU - Costamagna, Guido
PY - 2012/8
Y1 - 2012/8
N2 - BACKGROUND: The appropriate selection of patients for colonoscopy is crucial for an efficient use of endoscopy. The role of endoscopist in filtering out inappropriate referrals is largely unknown. METHODS: A multicentre, prospective study was performed in which consecutive patients referred for colonoscopy during a 1-month period were enrolled. Before colonoscopy, the endoscopist assessed appropriateness of the endoscopic referral without directly consulting official guidelines, also collecting clinical and demographic variables. Appropriateness of the indication was eventually assessed by a group of experts based on the American Society for Gastrointestinal Endoscopy guidelines, representing the gold standard. Outcomes of the study were the inappropriateness rate and the main related causes, as well as the concordance rate between the endoscopists and the experts. A multivariate analysis was performed to identify predictors of inappropriateness. RESULTS: One thousand seven hundred ninety-nine patients were enrolled in 20 centres, of which 1489 outpatients were included in the final analysis. According to the American Society for Gastrointestinal Endoscopy guidelines, 432 referrals were inappropriate, corresponding to an inappropriateness rate of 29%. At multivariate analysis, prescription of a repeated colonoscopy (≥2 colonoscopies in the same patient) was strongly associated with the inappropriateness of the indication (odds ratio: 8.8; 95% confidence interval: 6.2, 12.7). Postpolypectomy or post-colorectal cancer surveillance accounted for 77% of the inappropriate control procedures. A 79% concordance rate between endoscopist and expert assessment was found. Among the 317 discordant cases, postpolypectomy or post-colorectal cancer surveillance accounted for 51% of the cases, the endoscopists mistakenly classifying it as appropriate in 55% to 61% of the inappropriate cases. CONCLUSIONS: Inappropriateness in outpatient colonoscopy referrals remains high, surveillance procedures representing the most frequent source of inappropriateness.
AB - BACKGROUND: The appropriate selection of patients for colonoscopy is crucial for an efficient use of endoscopy. The role of endoscopist in filtering out inappropriate referrals is largely unknown. METHODS: A multicentre, prospective study was performed in which consecutive patients referred for colonoscopy during a 1-month period were enrolled. Before colonoscopy, the endoscopist assessed appropriateness of the endoscopic referral without directly consulting official guidelines, also collecting clinical and demographic variables. Appropriateness of the indication was eventually assessed by a group of experts based on the American Society for Gastrointestinal Endoscopy guidelines, representing the gold standard. Outcomes of the study were the inappropriateness rate and the main related causes, as well as the concordance rate between the endoscopists and the experts. A multivariate analysis was performed to identify predictors of inappropriateness. RESULTS: One thousand seven hundred ninety-nine patients were enrolled in 20 centres, of which 1489 outpatients were included in the final analysis. According to the American Society for Gastrointestinal Endoscopy guidelines, 432 referrals were inappropriate, corresponding to an inappropriateness rate of 29%. At multivariate analysis, prescription of a repeated colonoscopy (≥2 colonoscopies in the same patient) was strongly associated with the inappropriateness of the indication (odds ratio: 8.8; 95% confidence interval: 6.2, 12.7). Postpolypectomy or post-colorectal cancer surveillance accounted for 77% of the inappropriate control procedures. A 79% concordance rate between endoscopist and expert assessment was found. Among the 317 discordant cases, postpolypectomy or post-colorectal cancer surveillance accounted for 51% of the cases, the endoscopists mistakenly classifying it as appropriate in 55% to 61% of the inappropriate cases. CONCLUSIONS: Inappropriateness in outpatient colonoscopy referrals remains high, surveillance procedures representing the most frequent source of inappropriateness.
KW - appropriateness
KW - colonoscopy
KW - indication
UR - http://www.scopus.com/inward/record.url?scp=84863778267&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84863778267&partnerID=8YFLogxK
U2 - 10.1097/MCG.0b013e3182370b7b
DO - 10.1097/MCG.0b013e3182370b7b
M3 - Article
C2 - 22178958
AN - SCOPUS:84863778267
VL - 46
SP - 590
EP - 594
JO - Journal of Clinical Gastroenterology
JF - Journal of Clinical Gastroenterology
SN - 0192-0790
IS - 7
ER -