Face-to-face consultation model for assessing the appropriateness of indications for colonoscopy: let’s talk to the patient

Aims Over the last decades, the demand for colonoscopy has increased progressively, and it is currently the most requested test in digestive endoscopy. Waiting lists must be carefully managed to avoid delay in the diagnosis of patients with more serious pathology. Our aim is to assess the appropriateness of colonoscopy indications in a regional hospital and to prioritise or reject their performance in a face-to-face consultation.

Methods From January 2023 to June 2024, the doctors of the Digestive Service prospectively assessed the appropriateness of the indication of all requests for outpatient colonoscopy received, except their own, according to the suitability criteria of the AEGastrum-semFYC guide, establishing priority in their performance if the indication was appropriate and, otherwise or doubtful, contacting the requesting doctor when they came from the hospital setting. Doubtful indications, mainly from primary care, were resolved with the patient in person, explaining the inappropriateness of the indication if this was the case, with excellent acceptance by the patient [1] [2] [3].

Results 1092 requests for colonoscopy were reviewed (542 from primary care, 197 from colon cancer screening and 353 from in-hospital services). After prioritising which were appropriate, 170 (15.5%) patients were scheduled for consultation. All but 3 patients attended. Average time between receipt of the request and consultation: 26 days. After evaluation in consultation, the request for colonoscopy was considered adequate in 45 patients (26.4%), finding pathology in 23 patients, being relevant in 9 (5 not yet realised). The two main reasons for refusing colonoscopy were post-polypectomy follow-up and family history of colon cancer that did not conform to clinical guidelines (87 patients).

Conclusions In addition to the screening of the appropriatenes of requests for colonoscopy, face-to-face consultation can assist in decision making and avoidance of not appropriate examinations, with good patient acceptance. The most frequent reason for refusal of a request for colonoscopy is the post-polypectomy surveillance and family history of colon cancer that do not conform to guidelines or protocols.

Publication History

Article published online:
27 March 2025

• References

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