Appropriateness of colonoscopy in Europe (EPAGE II) – Chronic diarrhea and known inflammatory bowel disease

S. Schusselé Filliettaz; P. Juillerat; B. Burnand; C. Arditi; A. Windsor; C. Beglinger; R. W. Dubois; I. Peytremann-Bridevaux; V. Pittet; J.-J. Gonvers; F. Froehlich; J.-P. Vader; null and the EPAGE II Study Group

doi:10.1055/s-0028-1119627

Endoscopy 2009; 41(3): 218-226
DOI: 10.1055/s-0028-1119627

Original article

Appropriateness of colonoscopy in Europe (EPAGE II) – Chronic diarrhea and known inflammatory bowel disease

S. Schusselé Filliettaz¹ , P. Juillerat² , B. Burnand¹ , C. Arditi¹ , A. Windsor³ , C. Beglinger⁴ , R. W. Dubois⁵ , I. Peytremann-Bridevaux¹ , V. Pittet¹ , J.-J. Gonvers² , F. Froehlich^2, ⁴ , J.-P. Vader¹ , and the EPAGE II Study Group⁶

¹Healthcare Evaluation Unit, Institute of Social and Preventive Medicine, University of Lausanne and Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
²Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
³Department of Surgery, University College London Hospitals, London, United Kingdom
⁴Department of Gastroenterology, University of Basle, Basle, Switzerland
⁵Cerner LifeSciences, Beverly Hills, USA
⁶The EPAGE II Study Group[*]

Abstract

Background and study aims: To summarize the published literature on assessment of appropriateness of colonoscopy for investigation of chronic diarrhea, management of patients with known inflammatory bowel disease (IBD), and for colorectal cancer (CRC) surveillance in such patients, and to report report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II.

Methods: A systematic search of guidelines, systematic reviews, and primary studies regarding the evaluation of chronic diarrhea, the management of IBD, and colorectal cancer surveillance in IBD was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions.

Results: According to the literature, colonoscopic evaluation may be justified for patients aged > 50 years with recent-onset chronic diarrhea or with alarm symptoms. Surveillance colonoscopy for CRC should be offered to all patients with extensive ulcerative colitis or colonic Crohn’s disease of 8 years’ duration, and to all patients with less extensive disease of 15 years’ duration. Intervals for surveillance colonoscopy depend on duration of evolution, initial diagnosis, and histological findings. The EPAGE II criteria also confirmed the appropriateness of diagnostic colonoscopy for diarrhea of > 4 weeks’ duration. They also suggest that, in addition to assessing extent of IBD by colonoscopy, further colonoscopic examination is appropriate in the face of persistent or worsening symptoms. Surveillance colonoscopy in IBD patients was generally appropriate after a lapse of 2 years. In the presence of dysplasia at previous colonoscopy, it was not only appropriate but necessary.

Conclusions: Despite or perhaps because of the limitations of the available published studies, the panel-based EPAGE II (http://www.epage.ch) criteria can help guide appropriate colonoscopy use in the absence of strong evidence from the literature.

Volltext

Referenzen

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1 See Appendix: The EPAGE II Study Group

J.-P. VaderMD MPH

Institute of Social and Preventive Medicine

Rue du Bugnon 17
CH-1005 Lausanne
Switzerland

Fax: +41-21-3144954

eMail: john-paul.vader@chuv.ch

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