Iron-deficiency anemia and hematochezia: when is colonoscopy appropriate?

Details

Serval ID
serval:BIB_CFDD43E8F0BB
Type
Inproceedings: an article in a conference proceedings.
Publication sub-type
Abstract (Abstract): shot summary in a article that contain essentials elements presented during a scientific conference, lecture or from a poster.
Collection
Publications
Institution
Title
Iron-deficiency anemia and hematochezia: when is colonoscopy appropriate?
Title of the conference
77. Jahresversammlung der Schweizerischen Gesellschaft für Innere Medizin, Basel, 13.-15. Mai 2009
Author(s)
Gonvers J.J., Juillerat P., Peytremann-Bridevaux I., Arditi C., Froehlich F., O'Malley J., Fairclough P., Le Moine O., Dubois R., Schusselé-Filliettaz S., Vader J.P., Pittet V., Burnand B.
Address
Basel, Schweiz 13.-15. Mai 2009
ISBN
1424-3784
Publication state
Published
Issued date
2009
Volume
9
Series
Swiss Medical Forum = Forum Médical Suisse
Pages
12S
Language
english
Abstract
Background: Colonoscopy is usually proposed for the evaluation of lower gastrointestinal blood loss (hematochezia) or iron deficiency anemia (IDA). Clinical practice guidelines support this approach but formal evidence is lacking. Real clinical scenarios made available on the web would be of great help in decision-making in clinical practice as to whether colonoscopy is appropriate for a given patient. Method: A multidisciplinary multinational expert panel (EPAGE II) developed appropriateness criteria based on best published evidence (systematic reviews, clinical trials, guidelines) and experts' judgement. Using the explicit RAND Appropriateness Method (3 round of experts' votes and a panel meeting) 102 clinical scenarios were judged inappropriate, uncertain, appropriate, or necessary. Results: In IDA, colonoscopy was appropriate in patients >50 years and necessary in the presence of lower abdominal symptoms. In both men and women aged <50 years, colonoscopy was appropriate if prior sigmoidoscopy and/or gastroscopy did not explain the IDA, and necessary if lower gastrointestinal symptoms were present. In women <50 years with a potential gynecological cause, additional lower gastrointestinal symptoms rendered colonoscopy appropriate. In patients >50 years with hematochezia, colonoscopy was always appropriate and mostly necessary, except if a prior colonoscopy was normal within the previous 5 years. Under age 50 years, the presence of any risk factor for colorectal cancer (CRC) and no previous normal colonoscopy (within the last 5 years) made this procedure appropriate and necessary. Conclusion: Colonoscopy is appropriate and even necessary for many indications related to iron deficiency anemia or hematochezia, in particular in patients aged >50 years. The main factors influencing appropriateness are age, results of prior investigations (sigmoidoscopy, gastroscopy, previous colonoscopy), CRC risk and sex. EPAGE II appropriateness criteria are available on www.epage.ch
Create date
21/01/2010 16:12
Last modification date
20/08/2019 15:50
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