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©2005 Baishideng Publishing Group Inc.
World J Gastroenterol. Nov 28, 2005; 11(44): 7007-7013
Published online Nov 28, 2005. doi: 10.3748/wjg.v11.i44.7007
Published online Nov 28, 2005. doi: 10.3748/wjg.v11.i44.7007
Table 1 Demographic and clinical characteristic of 736 patients undergoing colonoscopy in Kuwait
| Characteristic | n (%) |
| Gender | |
| Male | 415 (56.4) |
| Female | 321 (43.6) |
| Age (yr) | |
| Mean age (SD) | 43.6 (16.6) |
| <15 | 31 (4.2) |
| 15-49 | 441 (59.9) |
| ≥50 | 264 (35.9) |
| Referring clinician | |
| General physician | 255 (34.6) |
| Surgeon | 246 (33.4) |
| Gastroenterologist | 205 (27.9) |
| Pediatric gastroenterologist | 22 (3.0) |
| Other1 | 8 (1.1) |
| Clinical status | |
| Inpatient | 130 (17.7) |
| Outpatient | 606 (82.3) |
Table 2 Indications for colonoscopy among 468 patients referred for reasons generally indicated according to the 2000 ASGE guidelines1
| Indication | n (%) |
| 1 Hematochezia | 151 (20.5) |
| 2 Clinically significant diarrhea of unexplained origin | 65(8.8) |
| 3 Irritable bowel syndrome or chronic abdominal pain: colonoscopy done once to rule out organic disease | 48(6.5) |
| 4 Chronic inflammatory bowel disease of the colon, if more precise diagnosis or determination of the extent of activity of disease will influence immediate management | 34 (4.6) |
| 5 Unexplained iron deficiency anemia | 27 (3.7) |
| 6 Following adequate clearance of neoplastic polyp(s) survey at 3-5 year intervals | 24 (3.3) |
| 7 Colonoscopy to remove synchronous neoplastic lesions at or around time of curative resection of cancer followed by colonoscopy at 3 years and 3-5 years thereafter to detect metachronous cancer | 23 (3.1) |
| 8 Evaluation of an abnormality on barium enema or other imaging study, which is likely to be clinically significant, such as a filling defect or stricture | 19 (2.6) |
| 9 Presence of fecal occult blood | 12 (1.6) |
| 10 Examination to evaluate the entire colon for synchronous cancer or neoplastic polyps in a patient with treatable cancer or neoplastic polyp | 11 (1.5) |
| 11 Excision of colonic polyp | 9 (1.2) |
| 12 Balloon dilation of stenotic lesions (e.g., anastomotic strictures) | 9 (1.2) |
| 13 Melena after an upper GI source has been excluded | 8 (1.1) |
| 14 In patients with ulcerative or Crohn's pancolitis eight or more years' duration or left sided colitis 15 or more years' duration every 1-2 years with systematic biopsies to detect dysplasia | 8 (1.1) |
| 15 Treatment of bleeding from such lesions as vascular malformation, ulceration, neoplasia, and polypectomy site (e.g., electrocoagulation, heater probe, laser or injection therapy) | 7 (1.0) |
| 16 Family history of sporadic colorectal cancer before the age of 60: colonoscopy every 5 years beginning at the age of 10 years earlier than the affected relative or every three years if adenoma is found | 6 (0.8) |
| 17 Intraoperative identification of a lesion not apparent at surgery (e.g., polypectomy site, location of a bleeding site) | 3 (0.4) |
| 18 Family history of hereditary non-polyposis colorectal cancer: colonoscopy every two years beginning at the age of 25, or five years younger than the earliest age of diagnosis of colorectal cancer. Annual colonoscopy beginning at the age of 40 | 2 (0.3) |
| 19 Palliative treatment of stenosing or bleeding neoplasms (e.g., laser, electrocoagulation, stenting) | 2 (0.3) |
Table 3 Indications for colonoscopy among 149 patients referred for reasons generally not indicated according to the 2000 ASGE guidelines1
| Indication | n (%) |
| 1 Chronic, stable, irritable bowel syndrome or chronic abdominal pain | 117 (15.9) |
| 2 Routine follow-up of inflammatory bowel disease | 15 (2.0) |
| 3 Acute diarrhea | 7 (1.0) |
| 4 Metastatic adenocarcinoma of unknown primary site in the absence of colonic signs or symptoms when it will not influence management | 6 (0.8) |
| 5 Upper GI bleeding or melena with a demonstrated upper gastrointestinal source | 4 (0.5) |
Table 4 Indications for colonoscopy among 119 patients referred for reasons not listed in the 2000 ASGE guidelines1
| Indication | n (%) |
| 1 Constipation | 71 (9.6) |
| 2 Unexplained weight loss | 14 (1.9) |
| 3 Normochromic anemia | 7 (1.0) |
| 4 Perianal abscess or fistula | 6 (0.8) |
| 5 Abdominal mass of unknown origin | 4 (0.5) |
| 6 Periodic follow up of healed benign lesions | 4 (0.5) |
| 7 Surveillance after resection of colonic polyps or cancer, at different intervals from those recommended | 3(0.4) |
| 8 Intestinal obstruction | 2 (0.3) |
| 9 Routine examination of the colon in patients with no colon-related signs or symptoms about to have elective abdominal surgery for non-colonic disease | 2 (0.3) |
| 10 Others | 6 (0.8) |
Table 5 Appropriateness of indication and diagnostic yield of colonoscopy according to patients’ characteristics
| Characteristic (no. of patients) | Appropriateness of referral1n (%) | Diagnostic yield (%) | ||
| Generally indicated | Generally not indicated | Not listed | ||
| All patients (736) | 468 (63.6) | 149 (20.2) | 119 (16.2) | 27.2 |
| Diagnostic yield | 37.80% | 4.70% | 13.40% | - |
| Gender | ||||
| Male (415) | 263(63.4) | 87 (21.0) | 65 (15.7) | 28 |
| Female (321) | 205 (63.9) | 62 (19.3) | 54 (16.8) | 26.2 |
| Age (yr) | ||||
| Mean age (SD) | 44.7 (17.3) | 38.2 (12.1) | 46.3 (17.3) | |
| <15 (31) | 24 (77.4) | 2 (6.5) | 5 (16.1) | 48.4 |
| 15-49 (441) | 247 (56.0) | 130 (29.5) | 64 (14.5) | 22.2 |
| ≥50 (264) | 197 (74.6) | 17 (6.4) | 50 (18.9) | 33 |
| Referring clinician | ||||
| General physician (255) | 154 (60.4) | 63 (24.7) | 38 (14.9) | 18 |
| Surgeon (246) | 153 (62.2) | 34 (13.8) | 59 (24.0) | 27.6 |
| Gastroenterologist (205) | 137 (66.8) | 49 (23.9) | 19 (9.3) | 36.6 |
| Pediatric gastroenterologist (22) | 18 (81.8) | 1 (4.5) | 3 (13.6) | 50 |
| Other2 (8) | 6 (75.0) | 2 (25.0) | 0 | 0 |
| Clinical status | ||||
| Inpatient (130) | 89 (68.5) | 19 (14.6) | 22 (16.9) | 35.4 |
| Outpatient (606) | 379 (62.5) | 130 (21.5) | 97 (16.0) | 25.4 |
Table 6 Clinical findings on colonoscopy by appropriateness of referral
Table 7 Odds ratios (OR) and 95% confidence intervals (95% CI) for association between selected clinical parameters and diagnostic yield of colonoscopy
| Parameter (n) | Diagnostic yield (%) | OR1 (95% CI2) | P |
| Gender | |||
| Female (321) | 26.2 | 1 | - |
| Male (415) | 28 | 1.1 (0.8-1.5) | >0.50 |
| Age (years) | |||
| <50 (472) | 23.9 | 1.0 - | |
| ≥50 (264) | 33 | 1.6 (1.1-2.2) | <0.05 |
| Clinical status | |||
| Outpatient (606) | 25.4 | 1 | - |
| Inpatient (130) | 35.4 | 1.6 (1.1-2.4) | <0.05 |
| Referring clinician | |||
| Other (531) | 23.5 | 1 | - |
| Gastroenterologist (205) | 36.6 | 1.9 (1.3-2.7) | <0.001 |
| Appropriateness of indication3 | |||
| Generally not indicated (149) | 4.7 | 1 | - |
| Not listed (119) | 13.4 | 3.2 (1.3-7.9) | <0.05 |
| Generally indicated (468) | 37.8 | 12.3 (5.7-27.0) | <0.001 |
- Citation: Siddique I, Mohan K, Hasan F, Memon A, Patty I, Al-Nakib B. Appropriateness of indication and diagnostic yield of colonoscopy: First report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy. World J Gastroenterol 2005; 11(44): 7007-7013
- URL: https://www.wjgnet.com/1007-9327/full/v11/i44/7007.htm
- DOI: https://dx.doi.org/10.3748/wjg.v11.i44.7007