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.
