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Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE)

Burnand, B ; Harris, J ; Wietlisbach, V ; Froehlich, F ; Vader, JP ; Gonvers, J ; study group, EPAGE and Toth, Ervin LU (2006) In Gastrointestinal Endoscopy 63(7). p.1018-1026
Abstract
Abstract in Undetermined
Background
Screening for colorectal cancer (CRC) has been shown to decrease mortality.

Objective
To examine determinants associated with having (1) a screening colonoscopy, (2) an appropriate indication for screening, and (3) a significant diagnosis at screening.

Design
Prospective observational study.

Setting
Twenty-one endoscopy centers from 11 countries.

Patients
Asymptomatic patients who underwent a colonoscopy for the purpose of detecting CRC and who did not have a history of polyps or CRC, a lesion observed at a recent barium enema or sigmoidoscopy, or a recent positive fecal occult blood test.

Intervention
Screening... (More)
Abstract in Undetermined
Background
Screening for colorectal cancer (CRC) has been shown to decrease mortality.

Objective
To examine determinants associated with having (1) a screening colonoscopy, (2) an appropriate indication for screening, and (3) a significant diagnosis at screening.

Design
Prospective observational study.

Setting
Twenty-one endoscopy centers from 11 countries.

Patients
Asymptomatic patients who underwent a colonoscopy for the purpose of detecting CRC and who did not have a history of polyps or CRC, a lesion observed at a recent barium enema or sigmoidoscopy, or a recent positive fecal occult blood test.

Intervention
Screening colonoscopy.

Main Outcome Measurements
Appropriateness according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria and significant diagnoses (cancer, adenomatous polyps, new diagnoses of inflammatory bowel disease, angiodysplasia).

Results
Of 5069 colonoscopies, 561 (11%) were performed for screening purposes. Patients were more likely to have a screening colonoscopy if they were aged 45 to 54 years (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.60-3.99). Screening colonoscopies were appropriate, uncertain, and inappropriate in 26%, 60%, and 14% of cases, respectively. Eighty-one significant diagnoses were made, including 4 cancers. Significant diagnoses were more often made for uncertain/appropriate indications (OR 3.20, 95% CI 1.12-9.17) than for inappropriate indications.

Limitations
Although data completeness was asked of all centers, it is possible that not all consecutive patients were included. Participating centers were a convenience sample and thus may not be representative.

Conclusions
About 1 of 10 colonoscopies were performed for screening, preferentially in middle-aged individuals. A higher diagnostic yield in uncertain/appropriate indications suggests that the use of appropriateness criteria may enhance the efficient use of colonoscopy for screening. (Less)
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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Gastrointestinal Endoscopy
volume
63
issue
7
pages
1018 - 1026
publisher
Elsevier
external identifiers
  • scopus:33646900450
ISSN
1097-6779
DOI
10.1016/j.gie.2006.01.051
language
English
LU publication?
yes
additional info
The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Medical Radiology Unit (013241410), Emergency medicine/Medicine/Surgery (013240200)
id
a4c3668e-b5c1-4e3c-a1b5-a0a56d3d3199 (old id 1542473)
alternative location
http://www.sciencedirect.com/science/article/pii/S0016510706002136
http://www.ncbi.nlm.nih.gov/pubmed/16733119
date added to LUP
2016-04-01 17:13:48
date last changed
2021-09-15 01:53:10
@article{a4c3668e-b5c1-4e3c-a1b5-a0a56d3d3199,
  abstract     = {Abstract in Undetermined<br/>Background<br/>Screening for colorectal cancer (CRC) has been shown to decrease mortality.<br/><br/>Objective<br/>To examine determinants associated with having (1) a screening colonoscopy, (2) an appropriate indication for screening, and (3) a significant diagnosis at screening.<br/><br/>Design<br/>Prospective observational study.<br/><br/>Setting<br/>Twenty-one endoscopy centers from 11 countries.<br/><br/>Patients<br/>Asymptomatic patients who underwent a colonoscopy for the purpose of detecting CRC and who did not have a history of polyps or CRC, a lesion observed at a recent barium enema or sigmoidoscopy, or a recent positive fecal occult blood test.<br/><br/>Intervention<br/>Screening colonoscopy.<br/><br/>Main Outcome Measurements<br/>Appropriateness according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria and significant diagnoses (cancer, adenomatous polyps, new diagnoses of inflammatory bowel disease, angiodysplasia).<br/><br/>Results<br/>Of 5069 colonoscopies, 561 (11%) were performed for screening purposes. Patients were more likely to have a screening colonoscopy if they were aged 45 to 54 years (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.60-3.99). Screening colonoscopies were appropriate, uncertain, and inappropriate in 26%, 60%, and 14% of cases, respectively. Eighty-one significant diagnoses were made, including 4 cancers. Significant diagnoses were more often made for uncertain/appropriate indications (OR 3.20, 95% CI 1.12-9.17) than for inappropriate indications.<br/><br/>Limitations<br/>Although data completeness was asked of all centers, it is possible that not all consecutive patients were included. Participating centers were a convenience sample and thus may not be representative.<br/><br/>Conclusions<br/>About 1 of 10 colonoscopies were performed for screening, preferentially in middle-aged individuals. A higher diagnostic yield in uncertain/appropriate indications suggests that the use of appropriateness criteria may enhance the efficient use of colonoscopy for screening.},
  author       = {Burnand, B and Harris, J and Wietlisbach, V and Froehlich, F and Vader, JP and Gonvers, J and study group, EPAGE and Toth, Ervin},
  issn         = {1097-6779},
  language     = {eng},
  number       = {7},
  pages        = {1018--1026},
  publisher    = {Elsevier},
  series       = {Gastrointestinal Endoscopy},
  title        = {Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE)},
  url          = {http://dx.doi.org/10.1016/j.gie.2006.01.051},
  doi          = {10.1016/j.gie.2006.01.051},
  volume       = {63},
  year         = {2006},
}