Colonoscopy appropriateness: Really needed or a waste of time?

Table 1 Summary box

Appropriateness guidelines and prioritising criteria have been developed to lessen colonoscopy workload in endoscopy units

The sensitivity of EPAGE II criteria is higher than that of EPAGE I criteria for detecting significant colorectal lesions (especially CRC); however, specificity should be further improved. Since these criteria are not perfect, in clinical practice, they should be used to assist the clinician before requesting a colonoscopy but they should not be the sole criteria for the decision

Although EPAGE II criteria might be used to cancel inappropriate colonoscopy referrals, in clinical practice they should be used with caution, because some life-threatening lesions are missed, even in inappropriate requests

NICE criteria used for prioritising colonoscopy are not accurate enough for detecting advanced colorectal neoplasms, but may be improved in combination with other markers (i.e., immunochemical fecal occult blood tests)

Adherence to guidelines required to decrease inappropriate indications and colonoscopy waiting lists

EPAGE: European panel appropriateness of gastrointestinal endoscopy; CRC: Colorectal cancer; NICE: National Institute for Health and Clinical Excellence.