10. Appropriateness of Colonoscopy: Diarrhea [1]

Introduction

The number of potential causes of diarrhea is very large. The easiest and most useful method of classifying diarrhea is according to its duration. The majority of cases of acute diarrhea are mild and caused by self-limiting infections or other processes, and thus no diagnostic intervention is indicated.

For patients with chronic diarrhea, diagnostic testing is usually indicated, but although endoscopy may be useful for patients with chronic diarrhea, it is unclear whether the initial procedure should be a flexible sigmoidoscopy or colonoscopy.

In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [1], and of the whole process, as well as the global results of the panel [2], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing.

This article presents a literature review on diarrhea that was provided to the panelists for study and comment prior to the panel meeting to support their ratings of appropriateness of use of colonoscopy in diarrhea. This article furthermore presents an overview of the main panel results related to diarrhea and a summary of published evidence and panel-based appropriateness criteria.

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland).

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1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland).