Samarakoon Yasara, Gunawardena Nalika, Pathirana Aloka, Hewage Sumudu
National Cancer Control Programme, No.555, Public Health Building Complex, Elvitigala Mawatha, Colombo, 5, Sri Lanka.
World Health Organization Country Office for Sri Lanka, No. 5, Anderson road, Colombo, 5, Sri Lanka.
BMC Gastroenterol. 2018 May 29;18(1):72. doi: 10.1186/s12876-018-0798-7.
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.
由于资源有限，决定患者是否接受结肠镜检查的临床决策需要基于证据，而不论其可及性、可负担性和安全性如何。本研究评估了在斯里兰卡选定研究地点进行的结肠镜检查的适宜性。在缺乏当地指南的情况下，审核依据欧洲胃肠内镜适宜性小组II（EPAGE II）标准进行。
这项横断面研究评估了2015年6月至8月期间在斯里兰卡四家主要医院接受结肠镜检查的连续患者。由经过培训的卫生工作人员通过访谈问卷和收集二手数据。根据EPAGE II标准评估适应证。
325例患者中，男女比例分别为57.2%和42.8%。平均（标准差）年龄为54.9（12.1）岁。结肠镜检查适宜的占61.2%（95%可信区间55.8 - 66.3），不确定的占28.6%（95%可信区间23.9 - 33.7），不适宜的占10.2%（95%可信区间7.3 - 13.9）。为评估腹痛进行的结肠镜检查不适宜的比例最高，为10.0%。然而，这些结肠镜检查中有9.5%发现了结直肠癌（CRC），这反映了当地CRC患者情况的差异。适应证适宜或不确定的结肠镜检查发现相关病变的可能性是不适宜适应证的三倍（42.5%对18.2%；比值比3.32，95%可信区间1.33 - 8.3；P = 0.008）。
大多数结肠镜检查是适宜的。然而，不能忽视的是每十名患者中就有一人接受了不适宜的结肠镜检查。因慢性腹痛适应证进行结肠镜检查时不适宜比例最高，其中9.5%的患者被诊断为CRC。这可能反映了当地CRC患者在症状表现和其他特征方面的不同情况。总之，作者建议根据当前最佳证据和当地患者情况制定结肠镜检查适应证的国家指南。使用这样制定的当地指南将提高有限资源的有效利用。
