The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE)

Gastrointestinal endoscopy has achieved a high standard of accuracy and efficacy in the exploration of the lumen of the digestive tract; this explains the widespread diffusion of the procedure and its major role in the detection and management of digestive diseases, both malignant and nonmalignant. However, its benefits must be weighed against: (i) the variable but generally high costs of the procedure; (ii) the potential risk of complications, and (iii) poor acceptance or tolerance by patients.

Many studies have been devoted to the cost-effectiveness of endoscopy; they should be preceded however by an evaluation of which indications are appropriate or inappropriate. Appropriate use of endoscopy is to be fostered, thus limiting both over- and underuse of the procedure. Indications should be explored in terms of the outcome after the procedure. Such outcomes will include the detection of disease, impact on treatment and, of course, the physical and psychological wellbeing of the patient. Alternative diagnostic methods should also be concurrently explored, and the necessary nature of a procedure determined when there is a substantial and probable benefit and when no other cost-effective procedure is available.

In recent years the Lausanne group has been very active in the evaluation of digestive endoscopy. Its most recent contribution to this field is the organization and conducting of a multicountry and multidisciplinary study, using the RAND methodology for decision analysis. Virtually all situations where gastroscopy or colonoscopy has been proposed were examined in terms of appropriateness. The work conducted by a panel of specialists was supported by an extensive review of literature. The fruits of this considerable amount of work are now published in a special issue of this Journal, with different chapters combining the literature basis and the findings of the panel for major clinical categories.

The European Society of Gastrointestinal Endoscopy endorsed this considerable project, and is pleased to patronise it with the hope that it will contribute to its own campaign for European endoscopy guidelines, thus promoting more harmony throughout Europe, from North to South and from East to West.

We are grateful to the Lausanne group for this sizeable project.

R. Lambert Scientific Advisor to the ESGE