Appropriateness of Indication and Diagnostic Yield of Colonoscopy in a Southern Nigerian Tertiary Hospital

Abstract

Background and Objectives: For optimum use of resources in an open access system, official guidelines for the appropriate use of colonoscopy have been proposed by the American Society for Gastrointestinal Endoscopy (ASGE). The objectives of this study were to determine the appropriateness of referrals and to assess the diagnostic yield of colonoscopy based on the 2000 ASGE guidelines. Methods: This was a retrospective study of patients that had colonoscopy in the University of Benin Teaching Hospital from January 2010 to December 2014. The biodata, indications for the procedure, and findings at colonoscopy were retrieved from the colonoscopy register of the endoscopy unit. The year 2000 ASGE guidelines were used to determine the appropriateness of indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for the indication. Results: Of the 283 patients (158 males; 125 females; mean age 55.2±15.0 years) studied, 66% had colonoscopy for an indication that was considered ‘generally indicated’. It was ‘generally not indicated’ for 2.5%, while 31.4% underwent colonoscopy for reasons ‘not listed’ in the guidelines. The diagnostic yield of the procedure was significantly higher in the ‘generally indicated’ group (41.7%) than in the ‘not listed’ (29.2%) and the generally not indicated (0%) groups. In the multivariate analysis, diagnostic yield was associated with appropriateness of indications that was’ generally indicated’ (odds ratio=1.263, confidence interval=1.072-1.488). Conclusion: About one third of patients had colonoscopy performed for reasons considered inappropriate by the ASGE 2000 guidelines. The diagnostic yield of colonoscopy is predicted by the appropriateness of the indication. Positive diagnostic yield also occurs in the unlisted category. Further studies are required to evaluate the indications for colonoscopy and the possibility of adding some of the unlisted indications to the ASGE guidelines in future revisions. There is need to develop a local guideline well adapted to our environment.