• Appropriateness review
• Colonoscopy
• Diagnostic techniques and procedures

• Humans
• Colonoscopy/statistics & numerical data
• Colonoscopy/standards
• Cross-Sectional Studies
• Male
• Female
• Middle Aged
• Referral and Consultation/statistics & numerical data
• Tunisia
• Aged
• Adult
• Unnecessary Procedures/statistics & numerical data
• Practice Guidelines as Topic

• Humans
• Pandemics/prevention & control
• COVID-19/epidemiology
• Endoscopy, Gastrointestinal
• Colonoscopy
• Disease Outbreaks

• Colonoscopy
• Common data model
• Observational Medical Outcomes Partnership
• Polypectomy
• Population

• Adult
• Aged
• Aged, 80 and over
• Aging
• Cohort Studies
• Colonoscopy/economics
• Colonoscopy/trends
• Female
• Gastrointestinal Diseases
• Humans
• Male
• Middle Aged
• Republic of Korea
• Retrospective Studies
• Young Adult

• Colonoscopy
• Colorectal cancer
• Diagnostic yield
• Inpatients

Due to finite resources, the clinical decision to subject a patient to colonoscopy needs to be based on the evidence, regardless of its availability, affordability and safety. This study assessed the appropriateness of colonoscopies conducted in selected study settings in Sri Lanka. In the absence of local guidelines, audit was based on European Panel on Appropriateness of Gastrointestinal Endoscopy II (EPAGE II) criteria.

This cross-sectional study assessed consecutive patients who underwent colonoscopy between June to August 2015 at four main hospitals in Sri Lanka. Interviewer administered questionnaire and secondary data were collected by trained health staff. Indications were assessed according to EPAGE II criteria.

Out of 325 patients, male female proportions were 57.2 and 42.8%. Mean (SD) age was 54.9 (12.1) years. Colonoscopies were appropriate in 61.2% (95% CI 55.8–66.3), uncertain in 28.6% (95% CI 23.9–33.7) and inappropriate in 10.2% (95% CI 7.3–13.9). Colonoscopy to evaluate abdominal pain has highest percentage of inappropriateness of 10.0%. However, 9.5% of these colonoscopies revealed Colo-Rectal Cancer (CRC), reflecting differences in the profile of local CRC patients. Colonoscopies with appropriate or uncertain indications are three times more likely to have a relevant finding than inappropriate indications (42.5% vs. 18.2%; OR 3.32, 95% CI 1.33–8.3; P = 0.008).

Majority of colonoscopies are appropriate. However, it cannot be neglected that every one in ten patients undergo inappropriate colonoscopy. Proportion of inappropriateness was highest for the indication of chronic abdominal pain, of which, 9.5% of patients were diagnosed with CRC. This may reflect the different profile of local CRC patients in terms of symptom manifestation and other characteristics. In conclusion, the authors recommend formulation of national guidelines for colonoscopy indications based on current best evidence and local patient profile. Use of such prepared local guidelines will improve the efficient use of finite resources.

The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods.

• Adaptation
• Constipation
• Diagnosis
• Guideline
• Treatment

Colorectal cancer (CRC) is a major health problem in the Western world. The diagnostic process is a challenge in all health systems for many reasons: There are often no specific symptoms; lower abdominal symptoms are very common and mostly related to non-neoplastic diseases, not CRC; diagnosis of CRC is mainly based on colonoscopy, an invasive procedure; and the resource for diagnosis is usually scarce. Furthermore, the available predictive models for CRC are based on the evaluation of symptoms, and their diagnostic accuracy is limited. Moreover, diagnosis is a complex process involving a sequence of events related to the patient, the initial consulting physician and the health system. Understanding this process is the first step in identifying avoidable factors and reducing the effects of diagnostic delay on the prognosis of CRC. In this article, we describe the predictive value of symptoms for CRC detection. We summarize the available evidence concerning the diagnostic process, as well as the factors implicated in its delay and the methods proposed to reduce it. We describe the different prioritization criteria and predictive models for CRC detection, specifically addressing the two-week wait referral guideline from the National Institute of Clinical Excellence in terms of efficacy, efficiency and diagnostic accuracy. Finally, we collected information on the usefulness of biomarkers, specifically the faecal immunochemical test, as non-invasive diagnostic tests for CRC detection in symptomatic patients.

• Colorectal cancer
• Colonoscopy
• Primary health care
• Faecal immunochemical test
• Diagnostic yield
• Diagnostic accuracy
• Risk stratification
• Open endoscopy unit
• Practice guidelines
• Health plan implementation

• Colonoscopy/standards
• Europe
• Humans
• Patient Selection
• Practice Guidelines as Topic/standards
• Prospective Studies
• Quality Control

Accurate indication classification is critical for obtaining unbiased estimates of colonoscopy effectiveness and quality improvement efforts, but there is a dearth of published systematic classification approaches. The objective of this study was to evaluate the effects of data-source and adjudication on indication classification and on estimates of the effectiveness of screening colonoscopy on late-stage colorectal cancer diagnosis risk.

This was an observational study in members of four U.S. health plans. Eligible persons (n = 1039) were age 55–85 and had been enrolled for 5 years or longer in their health plans during 2006–2008. Patients were selected based on late-stage colorectal cancer diagnosis in a case–control design; each case patient was matched to 1–2 controls by study site, age, sex, and health plan enrollment duration. Reasons for colonoscopies received in the 10-year period before the reference date were collected from three medical records sources (progress notes; referral notes; procedure reports) and categorized using an algorithm, with committee adjudication of some tests. We evaluated indication classification concordance before and after adjudication and used logistic regressions with the Wald Chi-square test to compare estimates of the effects of screening colonoscopy on late-stage colorectal cancer diagnosis risk for each of our data sources to the adjudicated indication.

Classification agreement between each data-source and adjudication was 78.8-94.0% (weighted kappa = 0.53-0.72); the highest agreement (weighted kappa = 0.86-0.88) was when information from all data sources was considered together. The choice of data-source influenced the association between screening colonoscopy and late-stage colorectal cancer diagnosis; estimates based on progress notes were closest to those based on the adjudicated indication (% difference in regression coefficients = 2.4%, p-value = 0.98), as compared to estimates from only referral notes (% difference in coefficients = 34.9%, p-value = 0.12) or procedure reports (% difference in coefficients = 27.4%, p-value = 0.23).

There was no single gold-standard source of information in medical records. The estimates of colonoscopy effectiveness from progress notes alone were the closest to estimates using adjudicated indications. Thus, the details in the medical records are necessary for accurate indication classification.

• Adult
• Aged
• Aged, 80 and over
• Anti-Infective Agents/therapeutic use
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Case-Control Studies
• Colitis/metabolism
• Colitis, Ulcerative/metabolism
• Colon/metabolism
• Diverticulitis, Colonic/drug therapy
• Diverticulitis, Colonic/metabolism
• Diverticulosis, Colonic/metabolism
• Drug Therapy, Combination
• Female
• Fibroblast Growth Factor 2/metabolism
• Humans
• Inflammation/metabolism
• Intestinal Mucosa/metabolism
• Male
• Mesalamine/therapeutic use
• Metronidazole/therapeutic use
• Middle Aged
• Rifamycins/therapeutic use
• Rifaximin
• Syndecan-1/metabolism
• Treatment Outcome
• Tumor Necrosis Factor-alpha/metabolism

• cross sectional study
• family planning service provision
• primary care

• Endoscopy, Gastrointestinal/methods
• Esophageal Motility Disorders/diagnosis
• Esophageal Motility Disorders/pathology
• Gastroesophageal Reflux/diagnosis
• Gastroesophageal Reflux/pathology
• Gastrointestinal Motility
• Humans

• Colonoscopy/standards
• Humans
• Quality of Health Care