• DOI:10.1055/s-0028-1119643
• Corpus ID: 25164942

Appropriateness of colonoscopy in Europe (EPAGE II). Presentation of methodology, general results, and analysis of complications.

@article{Juillerat2009AppropriatenessOC,
  title={Appropriateness of colonoscopy in Europe (EPAGE II). Presentation of methodology, general results, and analysis of complications.},
  author={Pascal Juillerat and Isabelle Peytremann-Bridevaux and J.-P. Vader and Chantal Arditi and S{\'e}verine Schussel{\'e} Filliettaz and Robert W. Dubois and J. J. Gonvers and Florian Froehlich and Bernard Burnand and Val{\'e}rie E H Pittet},
  journal={Endoscopy},
  year={2009},
  volume={41 3},
  pages={
          240-6
        }
}

• P. Juillerat, I. Peytremann-Bridevaux, +7 authors V. Pittet
• Published 1 March 2009
• Medicine
• Endoscopy

BACKGROUND AND STUDY AIMS
Appropriate use of colonoscopy is a key component of quality management in gastrointestinal endoscopy. In an update of a 1998 publication, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE II) defined appropriateness criteria for various colonoscopy indications. This introductory paper therefore deals with methodology, general appropriateness, and a review of colonoscopy complications.

METHODS
The RAND/UCLA Appropriateness Method was used to evaluate the appropriateness of various diagnostic colonoscopy indications, with 14 multidisciplinary experts using a scale from 1 (extremely inappropriate) to 9 (extremely appropriate). Evidence reported in a comprehensive updated literature review was used for these decisions. Consolidation of the ratings into three appropriateness categories (appropriate, uncertain, inappropriate) was based on the median and the heterogeneity of the votes. The experts then met to discuss areas of disagreement in the light of existing evidence, followed by a second rating round, with a subsequent third voting round on necessity criteria, using much more stringent criteria (i. e. colonoscopy is deemed mandatory).

RESULTS
Overall, 463 indications were rated, with 55 %, 16 % and 29 % of them being judged appropriate, uncertain and inappropriate, respectively. Perforation and hemorrhage rates, as reported in 39 studies, were in general < 0.1 % and < 0.3 %, respectively

CONCLUSIONS
The updated EPAGE II criteria constitute an aid to clinical decision-making but should in no way replace individual judgment. Detailed panel results are freely available on the internet (www.epage.ch) and will thus constitute a reference source of information for clinicians.