Performance of Panel-Based Criteria to Evaluate the Appropriateness of Colonoscopy

A Prospective Study

Published in: Gastrointestinal Endoscopy, v. 48, no. 2, Aug. 1998, p. 128-136

Posted on RAND.org on December 31, 1997

by Florian Froehlich, Isabelle Pache, Bernard Burnand, John Paul Vader, Michael Fried, Christoph Beglinger, Georg A. Stalder, Klaus Gyr, Joel Thorens, Catherine Schneider, Jacqueline Kosecoff, Marvin Kolodny, Robert W. Dubois, Jean-Jacques Gonvers, Robert H. Brook

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Prospective data describing the appropriateness of use of colonoscopy based on detailed panel-based clinical criteria are not available. In a cohort of 553 consecutive patients referred for colonoscopy to two university-based Swiss outpatient clinics, the percentage of patients who underwent colonoscopy for appropriate, equivocal, and inappropriate indications and the relationship between appropriateness of use and the presence of relevant endoscopic lesions was prospectively assessed. This assessment was based on criteria of the American Society for Gastrointestinal Endoscopy and explicit American and Swiss criteria developed in 1994 by a formal panel process using the RAND/UCLA appropriateness method. The report concludes that the rate of inappropriate use of colonoscopy is substantial in Switzerland. Explicit criteria allow assessment of almost all indications encountered in clinical practice. In this study, all sets of appropriateness criteria significantly enhanced the probability of finding a relevant endoscopic lesion during colonoscopy.

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