Appropriateness af kolonoskopi: Værdien af Europæisk udviklede kriterier for en Dansk population

Introduction: In most clinical scenarios there is no hard evidence that performing an endoscopy will be appropriate for an individual patient. An expert opinion may then be the only guidance for the clinician. The usefulness of such expert opinions was studied in a European multicenter study, in which two Danish centers participated. This paper describes how the expert panel perceived the appropriateness of colonoscopies performed in a Danish population. Materials and methods: An expert panel of 14 European clinicians developed appropriateness criteria for colonoscopy. Each of two Danish endoscopy centers included 300 consecutive patients referred for colonoscopy, as part of a multinational study. Before the procedure the clinician identified the clinical scenario for the patient using guidelines posted on an Internet page. The clinician rated the appropriateness of the individual colonoscopy without knowing the appropriateness rating. Results: 30.5% (95% CI; 26.7-34.5%) and 3.7% (95% CI; 2.3-5.7%) of colonoscopies were rated as inappropriate by the panel and by the endoscopists, respectively. The same discrepancy in appropriateness ratings between the expert panel and the endoscopists was found in both centres. In 31.4% (95% CI; 26.3-36.9%) of colonoscopies rated as inappropriate or of uncertain appropriateness, a condition requiring treatment was found, and 4 of 22 cancers were found in this group. Discussion: Appropriateness criteria can be used as a guide for the clinician in deciding whether to perform a colonoscopy but are not judged sufficient in themselves to be the basis for decision making.