Copyright ©The Author(s) 2015.
World J Gastrointest Endosc. Feb 16, 2015; 7(2): 94-101
Published online Feb 16, 2015. doi: 10.4253/wjge.v7.i2.94
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
Table 2 Main indications for colonoscopy according to European panel appropriateness of gastrointestinal endoscopy II (
Iron deficiency anemia
Discomfort or pain in the lower abdomen persisting ≥ 3 mo
Uncomplicated chronic diarrhea
Assessment of ulcerative colitis
Assessment of Crohn disease
Colorectal cancer screening
Colorectal cancer screening in patients with inflammatory bowel disease
Surveillance colonoscopy after polypectomy
Surveillance colonoscopy after colorectal cancer resection
Table 3 European panel appropriateness of gastrointestinal endoscopy II studies addressing appropriateness and diagnostic yield
Ref.Design1 (referrals)EPAGE II2(% appropriate)S3 (95%CI)Sp (95%CI)PPV (95%CI)4NPV (95%CI)
Carrión et al[33] (2010)R 65582.080.3 (74.0-84.3)16.8 (14.9-18.5)24.8 (23.1-26.4)71.3 (63.1-78.6)
Arguello et al[9] (2012)R 61982.678.3 (73.8-82.4)34.4 (31.3-37.3)45.2 (42.6-47.6)69.6 (63.4-75.4)
Gimeno García et al[10] (2012)P 96889.593.1 (90.0-96.3)12.7 (10.0-15.0)38.8 (36.0-42.0)75.5 (67.0-84.0)
Eskeland et al[16] (2014)R 29591.092.6 (84.8-96.6)22.9 (17.8-29.0)31.3 (25.3-37.3)89.1 (80.7-97.5)
Table 4 Clinical criteria for prompt colonoscopy referral (2 wk) according to the National Institute for Health and Clinical Excellence in the United Kingdom[44]
Patients ≥ 40 yr with rectal bleeding and change of bowel habit persisting ≥ 6 wk
Patients ≥ 60 yr with rectal bleeding persisting ≥ 6 wk without a change in bowel habit and without anal symptoms
Patients ≥ 60 yr with a change of bowel habit persisting ≥ 6 wk without rectal bleeding
Patients with right lower abdominal mass
Patients with palpable rectal mass
Patients with unexplained iron deficiency anemia ( ≤ 11 g/100 mL in men and ≤ 10 g/100 mL in women)
Table 5 Scottish Intercollegiate Guidelines network referral criteria[45]
1 Persistent rectal bleeding without anal symptoms
2 Persistent change in bowel habit (> 6 wk)
3 Significant family history
4 Right-side abdominal mass
5 Palpable rectal mass
6 Unexplained iron deficiency anemia
7 Persistent diarrhea