Appropriate use of colonoscopy and risk of missing colorectal neoplasia

BACKGROUND. The evaluation systems for the appropriate use of Colonoscopy may be very helpful to increase the quality of the open access services for digestive endoscopy. However the risk of missing some relevant pathologies, such as colorectal cancer and polyps, may occur. The aim of this study was to evaluate if the application of the ASGE criteria could avoid such risk. METHODS. 4322 Colonoscopy (age 14-99 yrs, 57% females) have been performed in three openaccess Endoscopy Services in a county of North-eastern Italy, from January to October 2003. Whenever each patient underwent Colonoscopy he was assigned to one class of appropriateness according to ASGE criteria (edition 2000). The overall evaluation of appropriateness was calculated for all the Colonoscopies. The percentage of cases with colorectal neoplasms without an indication related to ASGE criteria was recorded. We have analysed those non-ASGE indications, where the Colonoscopy demonstrated the presence of neoplasms. RESULTS. In 4322 Colonoscopies we have evidenced 166 colorectal cancer and 777 cases of colorectal polyps. In 122 cases of the neoplasms (74%) the colonoscopies were performed with indications included in ASGE appropriateness criteria. In 43 cases (26%) the indications for Colonoscopy were not included: alteration of bowel habit (15), abdominal pain (11), search for neoplasia in case of metastasis of unknown origin (5), bowel occlusion (4), other (8). In 503 cases of the polyps (65%) the colonoscopies were performed with indications included in ASGE appropriateness criteria. In 274 cases (36%) the indications for Colonoscopy were not included CONCLUSIONS. According to previous studies (Rossi et al. Gastrointest Endoscospy 2002) the use of ASGE criteria for Digestive Endoscopy appropriateness allowed us to find a high percentage of neoplasms in the digestive tract. However an important percentage of colorectal cancers (26%) and polyps (36%) were evidenced in cases without ASGE indication