Clinical Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2005; 11(44): 7007-7013
Published online Nov 28, 2005. doi: 10.3748/wjg.v11.i44.7007
Appropriateness of indication and diagnostic yield of colonoscopy: First report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy
Iqbal Siddique, Krishna Mohan, Fuad Hasan, Anjum Memon, Istvan Patty, Basil Al-Nakib
Iqbal Siddique, Fuad Hasan, Basil Al-Nakib, Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
Iqbal Siddique, Krishna Mohan, Fuad Hasan, Istvan Patty, Basil Al-Nakib, Thunayan Al-Ghanim Gastroenterology Center, Al-Amiri Hospital, Kuwait
Anjum Memon, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr Iqbal Siddique, Department of Medicine, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait.
Telephone: +965-5319596 Fax: +965-5338907
Received: March 17, 2005
Revised: June 2, 2005
Accepted: June 9, 2005
Published online: November 28, 2005

AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE).

METHODS: A total of 736 consecutive patients (415 males, 321 females; mean age 43.6±16.6 years) undergoing colonoscopy during October 2001-March 2002 were prospectively enrolled in the study. The 2000 ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication.

RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered “generally indicated”, it was “generally not indicated” for 20%, and it was “not listed” for 16% in the guidelines. The diagnostic yield of colonoscopy was highest for the “generally indicated” (38%) followed by “not listed” (13%) and “generally not indicated” (5%) categories. In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was “generally indicated” (odds ratio=12.3) and referrals by gastroenterologist (odds ratio =1.9).

CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician’s specialty. Certain indications “not listed” in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines.

Keywords: Colonoscopy, Indications, Diagnostic yield, Guidelines, Appropriateness