Grassini Mario, Verna Carlo, Niola Paolo, Navino Monica, Battaglia Edda, Bassotti Gabrio
Gastroenterology and Endoscopy Unit, Cardinal Massaja Hospital, Asti, Italy.
World J Gastroenterol. 2007 Mar 28;13(12):1816-9; discussion 1819. doi: 10.3748/wjg.v13.i12.1816.
To evaluate if the guidelines for the appropriateness of performing colonoscopy by American Society for Gastrointestinal Endoscopy (AGSE) and Italian Society of Digestive Endoscopy (SIED) yield a good diagnostic efficacy and do not present risks of missing important colonic pathologies in an Italian population sample.
A total of 1017 consecutive patients (560 men and 457 women; mean age 64.4 +/- 16 years) referred to an open-access endoscopy unit for colonoscopy from July 2004 to May 2006 were evaluated according to ASGE and SIED guidelines for appropriateness of performing the procedure. Diagnostic yield was defined as the percentage of relevant colonic pathologies of the total number of colonoscopies performed.
About 85.2% patients underwent colonoscopy that was considered appropriate based on at least one ASGE or SIED criterion, while it was considered inappropriate for 14.8% of patients. The diagnostic yield of colonoscopy was significantly higher for appropriate colonoscopies (26.94% vs 10.6%, P < 0.001) than for inappropriate colonoscopies (5.3%). There was no missed colorectal cancer following the ASGE/SIED criteria.
ASGE/SIED guidelines have shown a good diagnostic yield and the rate of missing relevant colonic pathologies seems very low. Unfortunately, the percentage of inappropriate referrals for colonoscopy in an open-access endoscopy system is still high, despite the number of papers published on the issue and the definition of international guidelines. Further steps are required to update and standardize the guidelines to increase their diffusion and to promote educational programs for general practitioners.
评估美国胃肠内镜学会（AGSE）和意大利消化内镜学会（SIED）制定的结肠镜检查适宜性指南是否具有良好的诊断效能，以及在意大利人群样本中是否不存在遗漏重要结肠病变的风险。
对2004年7月至2006年5月期间转诊至一家开放式内镜检查单位进行结肠镜检查的1017例连续患者（560例男性和457例女性；平均年龄64.4±16岁），根据ASGE和SIED的结肠镜检查适宜性指南进行评估。诊断率定义为进行结肠镜检查的总数中相关结肠病变的百分比。
约85.2%的患者接受了基于至少一项ASGE或SIED标准被认为适宜的结肠镜检查，而14.8%的患者被认为不适宜。适宜的结肠镜检查的诊断率（26.94%对10.6%，P<0.001）显著高于不适宜的结肠镜检查（5.3%）。遵循ASGE/SIED标准没有漏诊结直肠癌。
ASGE/SIED指南显示出良好的诊断率，遗漏相关结肠病变的发生率似乎非常低。不幸的是，尽管发表了大量关于该问题的论文并制定了国际指南，但在开放式内镜检查系统中，结肠镜检查转诊不适宜的百分比仍然很高。需要采取进一步措施来更新和规范指南，以增加其传播，并促进针对全科医生的教育项目。
