Appropriateness of colonoscopy: Diagnostic yield and safety in guidelines

Table 3 Indications in 151 inappropriate colonoscopies

Indications	n	%
Surveillance of colonic polyps out of recommended intervals (3-5 yr intervals following adequate clearance of neoplastic polyps)	49	32.4
Transitory or already endoscopically investigated unmodified chronic abdominal pain	30	19.9
Transitory change in bowel habit	21	13.9
Colorectal carcinoma surveillance out of guidelines (colonoscopy to remove synchronous neoplastic lesion at or around time of curative resection of cancer followed by colonoscopy at 3 yr and 3-5 yr thereafter to detect metachronous cancer)	20	13.2
Melena with upper gastrointestinal source already identified	9	6.0
Screening in patients with family histories of sporadic colorectal cancer before age of 60 out of guidelines (colonoscopy every 5 yr beginning at the age of 10 yr earlier than the affected relative or every 3 yr if adenoma is found)	6	4.0
Hematochezia in patients < 40 yr without previous rectal evaluation	4	2.6
Follow-up for inflammatory bowel diseases out of recommended intervals. Chronic inflammatory bowel disease of the colon, if more precise diagnosis or determination of the extent of activity of disease will influence immediate management	3	2.0
In patients with ulcerative or Crohn’s pancolitis ≥ 8 yr or left sided colitis ≥ 15 yr every 1-2 yr with systematic biopsies to detect dysplasia
Anal symptoms	3	2.0
Rectal incontinence	2	1.3
Abnormal serologic markers (CEA, carcino Embriogenic Antigen, Cancer Antigen 19-9)	2	1.3
Metastatic adenocarcinoma of unknown origin without colonic symptoms when it will not influence management	1	0.7
Inguinal hernia	1	0.7