Factors Associated with the Applicability of EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) and the Suitability of Indications for Eso-Gastroduodenal Endoscopy in a West African Country

Background: EGDF’s reference examination for exploring the digestive tract has seen steadily increasing demands over the past few years. The exam can be expensive and often poorly tolerated. Its prescription must take the cost/be- nefit and its relevance into account. The EPAGE criteria were developed to allow the appropriate selection of endoscopic procedures. Objective: To determine the factors associated with the applicability and appropriateness of the EGDF indications by the EPAGE criteria in our context in order to limit the number of inadequate EGDFs. Material and Method: Prospective cross- sectional study on the applicability of EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) and the relevance of the indications for Eso-Gastro-Duodenal Fibroscopy (EGDF) according to the criteria of the EPAGE in two large public hospitals located in the central region of Ivory Coast over a period of 8 months from September 2019 to May 2020. The following parameters (age, sex, history and comorbidities of the patient, the indication of EGDF, the qualification of the prescriber, the EPAGE situation, the relevance of the indications according to EPAGE, the result of the EGDF) were collated classified into judgment criteria and analyzed via the site https://www.epage.ch/ depending on whether the indication was appropriate, uncertain or inappropriate. The difference was significant for a value of p ≤ 0.05. Results: This was 1010 EGDF. The indications for EGDF were epigastralgia, gastrointestinal haemorrhage, testing for PHT signs, heartburn, vomiting, dysphagia, chest pain, anemia, control, tumor assessment. The result of EGDF was normal (14.9%), non-significant lesions (47.5%) and significant lesions (37.6%). EPAGE was applicable in 93.8% of patients, and the indications for EGDF were considered appropriate in 54.2% of cases. The EPAGE criteria were significantly applicable and appropriate in cases of epigastralgia, digestive haemorrhage, heartburn, and vomiting but not applicable for the search for signs of PH, for non-significant lesions and for 1/3 of gastric cancer. Significant lesions predominated in patients with appropriate indications (p < 0.001), whereas some significant lesions had uncertain indications. Conclusion: In our context, the EPAGE criteria could constitute a useful tool for the diagnostic profitability of EGDF. The indications deemed appropriate are statically associated with significant lesions and advanced age. But EPAGE must be adapted to our indications and cannot replace the reasoning of the practitioner when faced with the suspicion of significant lesions.

Appropriateness of colonoscopy in Cocody teaching hospital center in 2010: A prospective study using criteria established by the European panel on the appropriateness of gastrointestinal endoscopy (EPAGE)

Aims: 1) To assess the feasibility of EPAGE criteria in clinical practice;2) To assess appropriateness colonoscopy using EPAGE criteria;3) To compare colonoscopy appropriateness and endoscopic lesions. Method: Hundred thirtynine consecutive patients explored by colonoscopy were included. The appropriateness of colonoscopy was evaluated by EPAGE criteria. Results: EPAGE criteria were applicable among 127 patients (91% of the cases). Colonoscopies were appropriate, uncertain and inappropriate in respectively 40%;27% and 24% of the cases. Rate of abnormal colonoscopies was significantly different between the 3 groups (p = 0.03). Cancers were diagnosed exclusively in the groups with appropriate and uncertain colonoscopies (11% and 5%). Colonic adenomas were observed in the three groups (appropriate (7%), uncertain (5%) and inappropriate (6%)). Subjects with uncertain indication were older (58.25 years;p = 0.035). Conclusion: EPAGE criteria are feasible in clinical practice in Cocody’s teaching hospital center. Colonoscopies are generally appropriate in our hospital. However, within sight of the significant number of normal colonoscopies and discovered lesions in uncertain indication, colonoscopy cannot concern exclusively calculation of a score of appropriateness.

EPAGE互联网指南判定患者是否适合结肠镜检查

Background: Few studies have examined how physicians perceive guidelines, much less their perceptions of an Internet presentation of such guidelines. This study assessed physicians’acceptance of an Internet-based guideline on the appropriateness of colonoscopy. Methods: Gastroenterologists participating in an international observational study consulted an Internet-based guideline for consecutive patients referred for colonoscopy. The guideline was produced by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE), using a validated method (RAND). Through the use of questionnaires, physicians were asked their opinions and perspectives of the guideline and website. Results: There were 289 patients included in the study. The mean time for consulting the website was 1.8 min, and it was considered easy to use by 86%of physicians. The recommendations were easily located for 82%of patients and physicians agreed with the appropriateness in 86%of cases. According to the EPAGE criteria, colonoscopy was appropriate, uncertain, and inappropriate in 59, 28, and 13%of patients, respectively. Conclusions: The EPAGE guideline was considered acceptable and user-friendly and the use, usefulness and relevance of the website were considered acceptable. However, its actual use will depend on the removal of certain organizational and cultural obstacles.

点石成金

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