LETTERS TO THE EDITOR

 

Appropriateness of indication for colonoscopies performed at VIII Health Care Area in Principado de Asturias (Spain)

Adecuación de la indicación de las colonoscopias realizadas en el Área VIII (Langreo) del Principado de Asturias

 

 

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Key words: Appropriateness. Colorectal cancer. Screening.

Palabras clave: Adecuación. Cáncer colorrectal.

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Dear Editor,

Having read carefully Cerdán-Santacruz et al. article (1), we agree with their conclusions: screening and early detection programs have showed their cost-effectiveness properties, and have obtained a lower incidence rate, earlier diagnosis, and a higher survival rate. In fact, the recommendation of using colonoscopy for colorectal screening in adults is a grade A evidence (2). Nevertheless, an over indication of it has been observed (3), representing a loss of efficiency.

A Key Process for Colon Cancer was established during the year 2010 by National Centre for Health Administration (SNS) and Local Governments (Consejería, and SESPA), to assure the appropriateness of indication for colonoscopy. The local panel of experts published the Guidelines to appropriateness of indication for colonoscopy in Asturias (3). In Eighth Health Care Area (Langreo, Asturias, Northern Spain) these Guidelines were introduced so in Primary Health Care so as in Specialized Health Care Services (Gastroenterology, and General Surgery).

Taking into account this lack of efficiency, the objective of this study was to analyze the appropriateness (or inappropriateness) of indication for colonoscopies performed in our Health Care Area, to unify and optimization criteria to deal with the screening program.

 

Methods

Electronic medical records from patients subjected to colonoscopy from January 1 to December 31 2011 were retrospectively analyzed. Appropriate or inappropriate criteria of their indication were registered in our database, following the Guidelines (3). Chi-squared test was performed to compare discrete variables. Results were considered statistically significant if p-value was smaller than or equal to 0.05.

 

Results

One thousand and fifty five patients were included (54.9% male and 45.1% female; with age 62.4 ± 14.8 years). One hundred and one patients came from Primary Health Care (9.6%). The results summarized in Table I are expressed as number of patients and percentage of each appropriation criteria.

 

 

In 122 patients, inappropriated criteria were found (11.6%).

In Primary Health Care, inappropriated criteria were observed in 11 patients (10.9%; p = 0.59). These inappropriated criteria included: postcolectomy control out of range, age smaller than 50 years, diverticular disease, and cancerophobia.

Pathologic findings were observed in 238 patients (22.6%): polyps in 17.4%, and colorectal cancer in 5.1%.

 

Discussion

1. In the Eighth Health Care Area, the inappropriateness of indication for colonoscopy resulted in lower number compared with others authors (4-8).

2. No significant differences in appropriateness of indication for colonoscopy were obtained between both levels of Health Care.

3. Premalignant and malignant colorectal disease were detected in similar proportions to published data (9).

 

Acknowledgement

This research has been performed into an online collaborative work environment thanks to Mr. José Simó.

 

Aroa González-Rodríguez¹, Miguel Ángel Martín-Morán¹, Pilar Rodríguez-García² and Sergio Pérez-Holanda^3
1Primary Health Care, ²Unit of Endoscopy, and ³Department of General Surgery. Hospital Valle Nalon. Langreo, Asturias. Spain.
VIII Health Care Area (SESPA, Principado de Asturias, Spain)

 

References

1. Cerdán-Santacruz C, Cano-Valderrama O, Cárdenas-Crespo S, Torres-García AJ, Cerdán-Miguel J. Colorectal cancer and its delayed diagnosis: have we improved in the past 25 years? Rev Esp Enferm Dig 2011; 103(9):458-63.         [ Links ]

2. The U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Internal Med 2008;149(9):627-37.         [ Links ]

3. Lauret Braña ME, Parra Blanco A, Suárez González A, López Rivas L, Blay Albors P, Rodríguez Gordaliza FJ, et al. Guía de uso adecuado de colonoscopia en Asturias. Oviedo: Servicio de Salud del Principado de Asturias. Subdirección de Gestión Clínica y Calidad. Unidad de Atención al Cáncer; 2010.         [ Links ]

4. Bridevaux IP, Silaghi AM, Vader JP, Froehlich F, Gonvers JJ, Burnand B. Appropriateness of colorectal cancer screening: appraisal of evidence by experts. Int J Qual Health Care 2006;18(3):177-82.         [ Links ]

5. Fernández-Esparrach G, Gimeno García AZ, Llach J, Pellisé M, Ginés A, Balaguer F, et al. Recomendaciones de utilización de la endoscopia: análisis de la probabilidad de encontrar lesiones significativas en los pacientes procedentes de la atención extrahospitalaria. Med Clin (Barc) 2007;129(6):205-8.         [ Links ]

6. Hassan C, di Giulio E, Pickhardt PJ, Zullo A, Laghi A, Kim DH, et al. Cost effectiveness of colonoscopy, based on the appropriateness of an indication. Clin Gastroenterol Hepatol 2008;6(11):1231-6.         [ Links ]

7. Carrión S, Marín I, Lorenzo Zúñiga V, Moreno de Vega V, Boix J. Adecuación de la indicación de la colonoscopia según los nuevos criterios de EPAGE II. Gastroenterol. Hepatol 2010;33(7):484-9.         [ Links ]

8. Argüello L, Pertejo V, Ponce M, Peiró S, Garrigues V, Ponce J. The appropriateness of colonoscopies at a teaching hospital: magnitude, associated factors, and comparison of EPAGE and EPAGE-II criteria. Gastrointest Endosc 2012;75(1):138-45.         [ Links ]

9. Paz Valiñas L, Atiensa Merino G. Evaluación de la eficacia y efectividad del cribado poblacional del cáncer colorrectal. Aplicabilidad en el Sistema Nacional de Salud. Santiago de Compostela: Servicio Galego de Saúde. Axencia de Avaliación de tecnologías Sanitarias de Galicia, avalia-t; 2002. Informe de evaluación INF2003/02.         [ Links ]