Abstract:
Background: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
