Appropriateness of colonoscopy in Europe (EPAGE II). Iron-deficiency anemia and hematochezia.

Details

Serval ID
serval:BIB_D38B3B70C2CA
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Appropriateness of colonoscopy in Europe (EPAGE II). Iron-deficiency anemia and hematochezia.
Journal
Endoscopy
Author(s)
Peytremann-Bridevaux I., Arditi C., Froehlich F., O'Malley J., Fairclough P., Le Moine O., Dubois R.W., Gonvers J.J., Schusselé Filliettaz S., Vader J.P., Juillerat P., Pittet V., Burnand B.
Working group(s)
EPAGE II Study Group
Contributor(s)
Agréus L., Beglinger C., Bytzer P., Delvaux M., Eckardt V., Fairclough P., Lacaine F., Le Moine O., Lorenzo-Zúñiga V., Minoli G., Numans M., Oertli D., O'Malley J., Windsor A.
ISSN
1438-8812 (Electronic)
ISSN-L
0013-726X
Publication state
Published
Issued date
2009
Peer-reviewed
Oui
Volume
41
Number
3
Pages
227-233
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't ; Review
Publication Status: ppublish
Abstract
BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of iron-deficiency anemia (IDA) and hematochezia, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II.
METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of IDA and hematochezia was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions.
RESULTS: IDA occurs in 2 %-5 % of adult men and postmenopausal women. Examination of both the upper and lower gastrointestinal tract is recommended in patients with iron deficiency. Colonoscopy for IDA yields one colorectal cancer (CRC) in every 9-13 colonoscopies. Hematochezia is a well-recognized alarm symptom and such patients are likely to be referred for colonoscopy. Colonoscopy is unanimously recommended in patients aged > or = 50. Diverticulosis, vascular ectasias, and ischemic colitis are common causes of acute lower gastrointestinal bleeding (LGIB); CRC is found in 0.2 %-11 % of the colonoscopies performed for LGIB. Most patients with scant hematochezia have an anorectal or a distal source of bleeding. The expert panel considered most clinical indications for colonoscopy as appropriate in the presence of IDA (58 %) or hematochezia (83 %).
CONCLUSION: Despite the limitations of the published studies, guidelines unanimously recommend colonoscopy for the investigation of IDA and hematochezia in patients aged > or = 50 years. These indications were also considered appropriate by EPAGE II, as were indications in patients at low risk for CRC with no obvious cause of bleeding found during adequate previous investigations.
Keywords
Anemia, Iron-Deficiency/pathology, Colonoscopy, Europe, Female, Gastrointestinal Hemorrhage/pathology, Guidelines as Topic, Humans, Male, Middle Aged
Pubmed
Web of science
Open Access
Yes
Create date
04/08/2009 9:14
Last modification date
20/08/2019 15:53
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