Aim: The aim of this study was to compare the diagnostic performance (expressed as the accuracy in detecting relevant pathologies) of two systems for the evaluation of the appropriateness of colonoscopy suggested by the American Society of Gastrointestinal Endoscopy (ASGE) and by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE). Methods: Patients referred for Colonoscopy to an University outpatients Clinic of North-eastern Italy, were consecutively included in this prospective observational study. Before the procedure was performed the endoscopist assigned the patients to one of the ASGE appropriateness class; afterwards another gastroenterologist, without prior knowledge of the result of ASGE assignement, identified the detailed clinical scenario for the patients, which correspond to scenarios examined by EPAGE (see www.epage.ch), by using a 9-point scale: 1-3 inappropriate; 4-6 uncertain; 7-9 appropriate. The relationship between appropriateness of use and the presence of relevant endoscopic lesions (ischemic colitis, diverticulitis, Crohn's colitis, solitary ulcer of rectum, ulcerative colitis, neoformations, polyps, stenosis) was assessed, calculating the sensitivity and the specificity for each of the ASGE criteria, and each of the EPAGE score. Each couple of sensitivity/specificity data was plotted to form a so-called ROC curve. The area under the ROC curve (AUC) provides a summary measure of test performance, and can vary from 0.5 for a useless test to 1.0 for a very accurate test. We compared the AUC (and 95% CI) of the ROC curve derived from the application of ASGE criteria against that derived from the application of the EPAGE criteria. Results: 2006 consecutive patients were included in the study; comparison of appropriateness criteria according to ASGE and EPAGE could be made for 1843 patients (803 M and 1040 F; mean age 47; range 15-96). The AUC of the ROC curve derived from the ASGE criteria was 0.552 (95% CI: 0.521-0.583), not significantly different than the AUC of the ROC curve derived from the EPAGE score that was 0.568 (95% CI: 0.538-0.598. p = 0,3834). Conclusions: On the basis of our results we can suggest that the diagnostic accuracy for relevant pathologies obtained by both systems (ASGE and EPAGE) is unsatisfactory. Aim: The aim of this study was to compare the diagnostic performance (expressed as the accuracy in detecting relevant pathologies) of two systems for the evaluation of the appropriateness of colonoscopy suggested by the American Society of Gastrointestinal Endoscopy (ASGE) and by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE). Methods: Patients referred for Colonoscopy to an University outpatients Clinic of North-eastern Italy, were consecutively included in this prospective observational study. Before the procedure was performed the endoscopist assigned the patients to one of the ASGE appropriateness class; afterwards another gastroenterologist, without prior knowledge of the result of ASGE assignement, identified the detailed clinical scenario for the patients, which correspond to scenarios examined by EPAGE (see www.epage.ch), by using a 9-point scale: 1-3 inappropriate; 4-6 uncertain; 7-9 appropriate. The relationship between appropriateness of use and the presence of relevant endoscopic lesions (ischemic colitis, diverticulitis, Crohn's colitis, solitary ulcer of rectum, ulcerative colitis, neoformations, polyps, stenosis) was assessed, calculating the sensitivity and the specificity for each of the ASGE criteria, and each of the EPAGE score. Each couple of sensitivity/specificity data was plotted to form a so-called ROC curve. The area under the ROC curve (AUC) provides a summary measure of test performance, and can vary from 0.5 for a useless test to 1.0 for a very accurate test. We compared the AUC (and 95% CI) of the ROC curve derived from the application of ASGE criteria against that derived from the application of the EPAGE criteria. Results: 2006 consecutive patients were included in the study; comparison of appropriateness criteria according to ASGE and EPAGE could be made for 1843 patients (803 M and 1040 F; mean age 47; range 15-96). The AUC of the ROC curve derived from the ASGE criteria was 0.552 (95% CI: 0.521-0.583), not significantly different than the AUC of the ROC curve derived from the EPAGE score that was 0.568 (95% CI: 0.538-0.598. p = 0,3834). Conclusions: On the basis of our results we can suggest that the diagnostic accuracy for relevant pathologies obtained by both systems (ASGE and EPAGE) is unsatisfactory.

Background. This prospective study examined the appropriate use of colonoscopy in an open-access system with the American Society for Gastrointestinal Encloscopy guidelines and determined whether the American Society for Gastrointestinal Endoscopy guidelines were associated with relevant endoscopic findings.Methods. In a cohort of 2221 consecutive patients referred for colonoscopy, the proportion of patients who underwent colonoscopy for appropriate indications was prospectively assessed. The relationship between appropriateness and the presence of clinically relevant endoscopic diagnoses was assessed by calculating (1) the positive and negative likelihood ratio of the indications; and (2) the change in the probability of relevant endoscopic diaposes in the presence of the American Society for Gastrointestinal Endoscopy criteria.Results. The rate for 'generally not indicated' colonoscopies was 37%. Relevant endoscopic diagnoses were present in 28.5% of cases with American Society for Gastrointestinal Endoscopy indications versus 20.1% of patients without appropriate indications. However, the risk of finding relevant diagnoses was significantly increased by American Society for Gastrointestinal Endoscopy criteria application (odds ratio (OR) 1.58; 99% Cl 1.20-2.07; p < 0.01). Furthermore, in both endoscopic situations (appropriate and not appropriate), the likelihood ratio, positive and negative, varied very little, suggesting a low predictivity for serious pathologies by the appropriate procedure.Conclusions. The use of an appropriateness evaluation system makes it possible to increase the probability of finding relevant endoscopic diseases. However, the exclusive use of such a system for selecting patients to undergo colonoscopy involves a relatively high risk of colorectal neoplasms going undetected. (C) 2005 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

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 open-access 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 indications.

OBJECTIVES: The aim of this study was to compare the diagnostic performance of the two systems for the evaluation of the appropriateness of upper digestive endoscopy suggested by the American Society of Gastrointestinal Endoscopy (ASGE) and by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE). METHODS: Patients referred for the upper digestive endoscopy (EGD) to a University Outpatients Clinic of Northeastern Italy were consecutively included in this prospective observational study. Before the EGD, the endoscopist assigned the patients to one of the ASGE appropriateness classes; another endoscopist then identified the detailed clinical scenario for the patients, which corresponds to scenarios examined by EPAGE by using a nine-point scale: 1–3 inappropriate; 4–6 uncertain; and 7–9 appropriate. The relationship between the appropriateness of use and the presence of relevant endoscopic lesions (neoplasms, ulcers, esophagitis, erosive gastritis/duodenitis, stenosis, and varices) was assessed, calculating the sensitivity and the specificity for each of the ASGE criteria, and each of the EPAGE scores, and plotting them to form a receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) provides a summary measure of test performance, and can vary from a minimum of 0.5 to a maximum of 1.0. We compared the AUC of the ROC curve derived from the ASGE criteria against that derived from the EPAGE criteria. RESULTS: A total of 2,300 consecutive patients were included in the study (42% men; mean age: 57.3; range: 12–99); comparison of appropriateness criteria according to the ASGE and EPAGE could be made for 2,000 patients. The AUC of the ROC curve derived from the ASGE criteria was 0.553 (95% CI: 0.527–0.579), significantly higher than the AUC of the ROC curve derived from the EPAGE score: 0.523 (95% CI: 0.497–0.549; p < 0.05). CONCLUSIONS: We suggest that the diagnostic yield for relevant endoscopic findings obtained by both the systems (ASGE and EPAGE) is low; slightly better results could be accomplished by the ASGE criteria.

Background: This prospective study examined the appropriate use of EGD in an open-access system with the American Society for Gastrointestinal Endoscopy (ASGE) guidelines and determined whether the ASGE guidelines were associated with relevant endoscopic findings. Methods: In a cohort of 1777 consecutive patients referred for open-access EGD, the proportion of patients who underwent EGD for appropriate indications was prospectively assessed. The relationship between appropriateness and the presence of clinically relevant endoscopic diagnoses was assessed by calculating (1) the likelihood ratio, positive and negative, of the indications; and (2) the change in the probability of relevant endoscopic diagnoses in the presence of the ASGE criteria. Results: The rate for EGDs “generally not indicated” was 15.6%. Relevant endoscopic diagnoses were present in 47.4% of cases with ASGE indications versus 28.8% of patients without appropriate indications as defined by the ASGE criteria (OR: 2.23; 99% CI [1.55, 3.22]; p < 0.01). A similar difference was observed for erosive gastritis (OR: 1.86; 99% CI [1.17, 2.95]; p < 0.01), erosive esophagitis (OR: 1.48; 99% CI [0.87, 2.52]; p < 0.05), and Barrett's esophagus (OR: 9.76; 99% CI [0.72, 132]; p < 0.05). The pretest probability of finding a relevant endoscopic diagnosis was modified slightly when an ASGE indication(s) was present and decreased markedly when ASGE criteria were absent. Conclusions: The use of the ASGE guideline for appropriate indications for EGD can improve patient selection for the procedure. However, to avoid missed diagnoses of serious disease, use of the guidelines must be tailored to the specific clinical setting. (Gastrointest Endosc 2002;56:714-9.)