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Review paper

Appropriateness of colonoscopy at a tertiary care centre – are we overdoing gastrointestinal endoscopy?

By
Nerma Čustović Orcid logo ,
Nerma Čustović
Contact Nerma Čustović

Clinic for Gastroenterohepatology, Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Lejla Džananović ,
Lejla Džananović

Statistics and Epidemiology Department, School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Ismar Rašić ,
Ismar Rašić

Department of Surgery, General Hospital “Prim.dr. Abdulah Nakaš”, Sarajevo, Bosnia and Herzegovina

Nadža Zubčević ,
Nadža Zubčević

Clinic for Gastroenterohepatology, Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Lejla Šaranović-Čečo ,
Lejla Šaranović-Čečo

Department for Gastroenterohepatology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Jasmina Redžepagić
Jasmina Redžepagić

Clinic for Pathology, Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Abstract

Aim
To evaluate the pattern of indications and a spectrum of colonic pathology, and to determine appropriateness of indications for colonoscopy in order to improve patient selection for colonoscopy.
Methods
This retrospective study includes 294 patients who were referred to the Gastroenterology Department from a primary care
physician in order to approach endoscopic examination. Study data included patients’ anamnestic data (comorbidities, positive family history, performed radiological examinations) an indication for the procedure, and colonoscopy findings.
Results
Haematochezia was confirmed in 186 (63.26%), positive radiologic finding in183 (62.24%) and anaemia in 157 (53.40%)
patients. Adenoma and colorectal carcinoma were detected in 40 (13.6%) and 53 (18%) patients, respectively. A significant association between haematochezia and colorectal neoplasm was confirmed (p=0.019), haematochezia and inflammatory bowel disease (p=0.027), and between radiological finding and colorectal neoplasm (p=0.018). There was no significant association between anaemia and any of the colonoscopic findings. According to EPAGE II criteria indications were appropriate in 187 (63.6%), uncertain in 67 (22.8%) and inappropriate in 40 (13.6%) patients.
Conclusion
This study confirmed a slightly larger number of uncertain and inappropriate indications for colonoscopy compared
to other studies that examined indications for colonoscopy, which can be attributed to a high number of patients with functional bowel disorders. 

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