Diagnostic yield of open access colonoscopy according to appropriateness

Background: Open-access endoscopy allows physicians to directly schedule en doscopic procedures for their patients without prior consultation. Evaluati on of both appropriateness and diagnostic yield of endoscopic procedures is critical when assessing the costs and benefits of endoscopy in an open-acc ess setting. The aim of this study was to assess the appropriate use of col onoscopy in an open-access system and to establish the yield of diagnostic information relevant to patient care. Methods: Overall, 1123 consecutive patients referred for open-access colono scopy were prospectively enrolled in the study. The American Society for Ga strointestinal Endoscopy (ASGE) guidelines were used to assess the relation ship between the appropriate use of colonoscopy and the presence of relevan t endoscopic findings. Results. The rate of colonoscopies "generally not indicated" according to A SGE guidelines was 29% (39% for primary care physicians and 23% for special ists; p<0.0001). A relevant endoscopic finding was detected in 338 examinat ions (35%). The diagnostic yield was significantly higher for "generally in dicated" colonoscopies (43%) compared with "generally not indicated" proced ures (16%) (p<0.001). Conclusions: Although the rate of inappropriate use of colonoscopy was high , open-access colonoscopy was effective in detecting neoplastic lesions. Be cause most of these were detected during examinations performed for appropr iate indications, the appropriateness of the indication emerges as crucial to the cost-effectiveness of an open-access system.