1. Clinical validation of the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) II criteria in an open-access unit: a prospective study
- Author
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Vanessa Felipe, Marta Carrillo, Laura Ramos, Alejandro Jiménez-Sosa, Miguel Moreno, Yanira González, A Z Gimeno García, O. Alarcon Fernandez, Zaida Adrian, David Nicolás-Pérez, Juan Carlos Diaz, Rafael Romero, Miguel T. Hernandez, and Enrique Quintero
- Subjects
Male ,medicine.medical_specialty ,Referral ,Colonoscopy ,Unnecessary Procedures ,Statistics, Nonparametric ,Article ,Predictive Value of Tests ,Internal medicine ,Positive predicative value ,medicine ,Humans ,False Positive Reactions ,Prospective Studies ,Prospective cohort study ,False Negative Reactions ,Referral and Consultation ,Early Detection of Cancer ,Aged ,Chi-Square Distribution ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Middle Aged ,Endoscopy ,Surgery ,Logistic Models ,Predictive value of tests ,Practice Guidelines as Topic ,Female ,Observational study ,Guideline Adherence ,Colorectal Neoplasms ,business ,Chi-squared distribution - Abstract
BACKGROUND AND STUDY AIMS The European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE I) criteria were recently updated (EPAGE II), but no prospective studies have used these criteria in clinical practice. The aim of the current study was to validate the EPAGE II criteria in an open-access endoscopy unit. PATIENTS AND METHODS A prospective observational study was conducted in an open-access endoscopy unit at a tertiary care referral center. Consecutive outpatients (n = 1004; mean age 58.9 ± 13.1 years; 45 % men) were referred for diagnostic colonoscopy between September 2009 and February 2010. The appropriateness of colonoscopy was assessed based on EPAGE II criteria, and the relationship between appropriateness and both referral doctor and detection of significant lesions was examined. The effectiveness of EPAGE II criteria in assessing appropriateness was measured by means of sensitivity, specificity, and positive and negative predictive values for detecting significant lesions. RESULTS Colonoscopic cecal intubation was achieved in 956 patients (95.2 %). Most referral doctors were gastroenterologists (58.0 %) and the most common indication was colorectal cancer (CRC) screening (35.2 %). EPAGE II criteria were applicable in 968 patients (96.4 %); of these patients, the indication was appropriate in 778 (80.4 %), inappropriate in 102 (10.5 %), and uncertain in 88 (9.1 %). Patients with appropriate or uncertain indications based on EPAGE II criteria had more relevant endoscopic findings than those with inappropriate indications (38.8 % vs. 24.5 %; OR 1.95, 95 %CI 1.22 - 3.13; P
- Published
- 2011
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