8. Appropriateness of Colonoscopy: Hematochezia [1]

Introduction

Lower GI bleeding (i. e. bleeding distal to the Treitz ligament) may be acute, chronic or occult. The most common causes cited in the literature vary greatly, in particular according to patient age. In acute bleeding, the large bowel should be investigated by anoscopy and sigmoidoscopy once the patient has been stabilized. If no potential source of bleeding is found, the entire colon should be investigated by colonoscopy. Colonoscopy is not only a diagnostic tool but also allows therapeutic intervention.

In chronic lower GI bleeding, it is essential to exclude colon cancer.

In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [1], and of the whole process, as well as the global results of the panel [2], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing.

This article presents a literature review on hematochezia, that was provided to the panelists to study and comment prior to the panel meeting to support their ratings of appropriateness of use of colonoscopy. This article furthermore presents an overview of the main panel results related to hematochezia and a summary of published evidence and panel-based appropriateness criteria.

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

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1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)