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World J Gastrointest Endosc. Feb 16, 2015; 7(2): 94-101
Published online Feb 16, 2015. doi: 10.4253/wjge.v7.i2.94
Colonoscopy appropriateness: Really needed or a waste of time?
Antonio Z Gimeno-García, Enrique Quintero
Antonio Z Gimeno-García, Enrique Quintero, Servicio de Gastroenterología, Hospital Universitario de Canarias, 38320 Tenerife, Spain
Antonio Z Gimeno-García, Enrique Quintero, Instituto Universitario de Tecnologías Biomédicas (ITB) and Centro de Investigación Biomédica de Canarias (CIBICAN), Departamento de Medicina Interna, Universidad de La Laguna, 38320 Tenerife, Spain
Author contributions: Gimeno-García AZ and Quintero E contributed to this paper; all authors have participated sufficiently in the conception of this review, as well as the writing, drafting and revising it critically for important intellectual content and final approval of the version to be published.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Z Gimeno-García, MD, PhD, Servicio de Gastroenterología, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320 Tenerife, Spain. antozeben@gmail.com
Telephone: +34-92-2678554 Fax: +34-92-2678554
Received: August 16, 2014
Peer-review started: August 16, 2014
First decision: September 16, 2014
Revised: October 17, 2014
Accepted: October 31, 2014
Article in press: November 3, 2014
Published online: February 16, 2015
Abstract

Technical and quality improvements in colonoscopy along with the widespread implementation of population screening programs and the development of open-access units have resulted in an exponential increase in colonoscopy demands, forcing endoscopy units to bear an excessive burden of work. The American Society for Gastrointestinal Endoscopy appropriateness guideline and the European panel appropriateness of gastrointestinal endoscopy guideline have appeared as potential solutions to tackle this problem and to increase detection rates of relevant lesions. Inappropriate indications based on either guideline are as high as 30%. Strategies based on these clinical criteria or other systems may be used to reduce inappropriate indications, thus decreasing waiting lists for outpatient colonoscopy, saving costs, prioritizing colonoscopy referrals and subsequently decreasing interval times from diagnosis to treatment. Despite the potential role of appropriateness guidelines, they have not been widely adopted partly due to fear of missing significant lesions detected in inappropriate indications. We review the main appropriateness and prioritising systems, their usefulness for detecting relevant lesions, as well as interventions based on those systems and cost-effectiveness.

Keywords: Colonoscopy appropriateness, European panel appropriateness of gastrointestinal endoscopy II, National Institute for Health and Clinical Excellence, Colonoscopy prioritisation, Open access endoscopy unit

Core tip: There is increasing worldwide demand for colonoscopy referrals, overburdening endoscopy units. Controlling the appropriateness of colonoscopy referrals has been proposed to decrease the increased workload. The American Society for Gastrointestinal Endoscopy appropriateness and the European panel appropriateness of gastrointestinal endoscopy guidelines, and prioritisation criteria such as those of the National Institute for Health and Clinical Excellence and the Scottish Intercollegiate Guidelines network are good candidates for this task. We review the available systems and interventions designed to rationalize colonoscopy demand.