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©2007 Baishideng Publishing Group Co.
World J Gastroenterol. Mar 28, 2007; 13(12): 1816-1819
Published online Mar 28, 2007. doi: 10.3748/wjg.v13.i12.1816
Published online Mar 28, 2007. doi: 10.3748/wjg.v13.i12.1816
Table 1 ASGE and SIED selection criteria for colonoscopies
ASGE | SIED |
Abnormality on barium enema | Abnormality on barium enema, 1Computerized Tomography scan, Magnetic Resonance Imaging, Ultrasonography |
Haematochezia–Fecal occult blood test positivity–melena after negative upper GI endoscopy | Haematochezia–Fecal occult blood test positivity-Melena after negative upper GI endoscopy |
Unexplained iron deficiency anemia | Unexplained iron deficiency anemia |
Surveillance for colonic neoplasia and colonic polyps | Surveillance for colonic neoplasia and colonic polyps |
Clinically significant diarrhea of unexplained origin | 1Persistent and significant alterations of bowel habits |
Surveillance of inflammatory bowel diseases patients | Surveillance of inflammatory bowel diseases patients |
Evaluation of inflammatory bowel diseases of colon when colonoscopy will influence immediate management | Evaluation of inflammatory bowel diseases of colon when colonoscopy will influence immediate management |
Chronic abdominal pain: once to rule out disease | Chronic abdominal pain: once to rule out disease |
1Unexplained weight loss |
Table 2 921 indications in 866 appropriate colonoscopies
ASGE/SIED guidelines | n | % |
Haematochezia | 218 | 23.7 |
Occult faecal blood presence | 154 | 16.7 |
Surveillance after endoscopic polypectomy | 136 | 14.7 |
(3-5 yr intervals following adequate clearance of neoplastic polyps) | ||
Persistent change in bowel habits | 105 | 11.4 |
Surveillance after resection of cancer | 100 | 10.8 |
(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) | ||
Chronic abdominal pain | 57 | 6.2 |
Unexplained iron deficiency anemia | 54 | 5.9 |
Family history of sporadic colorectal cancer before the age of 60: colonoscopy every 5 yr beginning at the age of 10 yr earlier than the affected relative or every 3 yr if adenoma is found | 42 | 4.6 |
Abnormality on imaging | 28 | 3.0 |
Unexplained weight loss | 18 | 1.9 |
Chronic inflammatory bowel disease of colon, if more precise diagnosis or determination of the extent of activity of disease will influence immediate management | 9 | 1.0 |
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 |
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 |
Table 4 Pathologic findings in appropriate colonoscopies
Pathologic findings | 866 appropriate | 151 inappropriate | ||
n | % | n | % | |
Low grade dysplasia adenoma | 92 | 41.8 | 9 | 6.0 |
Colorectal cancer | 71 | 32.3 | - | - |
Undetermined polyps (unretrieved polyps size < 5 mm) | 25 | 11.0 | 5 | 3.3 |
High grade dysplasia adenoma | 25 | 11.4 | 2 | 1.3 |
Inflammatory bowel diseases | 17 | 7.7 | - | - |
In situ adenocarcinoma | 3 | 1.4 | - | - |
233 | 26.9 | 16 | 10.6 |
- Citation: Grassini M, Verna C, Niola P, Navino M, Battaglia E, Bassotti G. Appropriateness of colonoscopy: Diagnostic yield and safety in guidelines. World J Gastroenterol 2007; 13(12): 1816-1819
- URL: https://www.wjgnet.com/1007-9327/full/v13/i12/1816.htm
- DOI: https://dx.doi.org/10.3748/wjg.v13.i12.1816