Introduction Open access endoscopy allows non-gastroenterologists to schedule elective endoscopies without prior consultation with a specialist and is widely used for upper gastrointestinal endoscopy. Our hospital has provided an open access service for colonoscopy (OAC) since May 2011. We analyse our initial data to determine the appropriateness of referral and proportion of clinically significant diagnoses found.
Methods We retrospectively reviewed endoscopy reports from all open access colonoscopies between 01/05/2011 and 30/04/2012 performed in a local district general hospital. Patient demographic data was collected alongside indication for examination, completion rates and final diagnosis. Further information from all colonoscopies performed during this period was retrieved from our endoscopy database system for comparison. Appropriateness of open access colonoscopy was graded using the European Panel on the Appropriateness of Gastrointestinal Endoscopy criteria (EPAGE II). Primary endpoint: appropriateness of colonoscopy. Secondary endpoint: clinically significant diagnosis.
Results 2895 colonoscopies were performed in total during the study period of which OAC accounted for 14% (407). 57% (231) patients were female, age range 24–89 years (median 56 years). Caecal intubation was achieved in 96% (389 patients). OAC had the lowest diagnostic yield for all outpatient referrals to colonoscopy compared to bowel cancer screening (86%), medical outpatients (61%) and surgical outpatients (57%). The indication was designated appropriate in 69% (279 patients), inappropriate in 6% (25 patients) and uncertain in 25% (103 patients) based on the EPAGE II criteria. Patients with appropriate or uncertain indications had more relevant endoscopic findings than those with inappropriate indications (45.8 vs 19.0% p = 0.005). Sensitivity and negative predictive value of the EPAGE II criteria for detecting clinically significant pathology were 97.7 and 83.3% respectively. The most common diagnosis was diverticular disease, followed by polyps and haemorrhoids (Table 1). Colorectal cancer was found in 0.5% (2 patients), both in the appropriate/uncertain EPAGE group based on indication.
Conclusion Open access to colonoscopy is useful to avoid delay in investigation of symptomatic patients but is associated with a low proportion of clinically significant findings compared to standard referral routes. Inclusion of the EPAGE II criteria in the referral form may help to avoid unnecessary examinations.
Disclosure of Interest None Declared.