Appropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer

Arditi, C. and Peytremann-Bridevaux, I. and Burnand, B. and Eckardt, V. F. and Bytzer, P. and Agréus, L. and Dubois, R. W. and Vader, J.-P. and Froehlich, F. and Pittet, V. and Schusselé Filliettaz, S. and Juillerat, P. and Gonvers, J.-J.. (2009) Appropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer. Endoscopy, Vol. 41, H. 3. pp. 200-208.

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Official URL: http://edoc.unibas.ch/dok/A6007681

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BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for screening for colorectal cancer (CRC) in asymptomatic individuals without personal history of CRC or polyps, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews, and primary studies regarding colonoscopy for screening for colorectal cancer was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy in these circumstances. RESULTS: Available evidence for CRC screening comes from small case-controlled studies, with heterogeneous results, and from indirect evidence from randomized controlled trials (RCTs) on fecal occult blood test (FOBT) screening and studies on flexible sigmoidoscopy screening. Most guidelines recommend screening colonoscopy every 10 years starting at age 50 in average-risk individuals. In individuals with a higher risk of CRC due to family history, there is a consensus that it is appropriate to offer screening colonoscopy at > 50 years. EPAGE II considered screening colonoscopy appropriate above 50 years in average-risk individuals. Panelists deemed screening colonoscopy appropriate for younger patients, with shorter surveillance intervals, where family or personal risk of colorectal cancer is higher. A positive FOBT or the discovery of adenomas at sigmoidoscopy are considered appropriate indications. CONCLUSIONS: Despite the lack of evidence based on randomized controlled trials (RCTs), colonoscopy is recommended by most published guidelines and EPAGE II criteria available online (http://www.epage.ch), as a screening option for CRC in individuals at average risk of CRC, and undisputedly as the main screening tool for CRC in individuals at moderate and high risk of CRC.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Gastroenterologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Gastroenterologie
UniBasel Contributors:Froehlich, Florian
Item Type:Article, refereed
Article Subtype:Further Journal Contribution
Publisher:Georg Thieme
Note:Publication type according to Uni Basel Research Database: Journal item
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Last Modified:18 Jul 2014 09:09
Deposited On:18 Jul 2014 09:09

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