The ASGE guidelines for the appropriate use of colonoscopy in an open access system

Background: Appropriateness of indications is essential to the rational uti lization of resources. The aim of this study was to evaluate the appropriat e use of colonoscopy in an open access system and to assess whether the Ame rican Society for Gastrointestinal Endoscopy (ASGE) guidelines are useful i n clinical practice. Methods: The indication for colonoscopy was assessed on 3000 consecutive ex aminations performed at 7 institutions. Results: The rate of colonoscopies "generally not indicated" according to t he ASGE guidelines was 24.5% for outpatients and 15.5% for inpatients; the rates of examinations performed for an indication not listed in the ASGE gu idelines were 12% and 20.1%, respectively. Generally not indicated colonosc opies were significantly less frequent for procedures requested by gastroen terologists or family physicians than those requested by other specialists, but were similar. Most generally not indicated examinations requested by g astroenterologists were for routine follow-up of patients with inflammatory bowel disease; when these patients were excluded, the rate of generally no t indicated endoscopies requested by gastroenterologists was also lower tha n the corresponding rate for examinations requested by family physicians. Conclusions: In Italy, the rate of colonoscopies performed for generally no t indicated reasons is high, particularly among examinations not requested by a gastroenterologist. Many colonoscopies are performed for indications n ot listed in the ASGE guidelines.