Colonoscopy demands a considerable amount of resources, and little is known about its diagnostic yield among inpatients.
To assess indications, diagnostic yield and findings of colonoscopy for inpatients, and to identify risk factors for relevant findings and cancer.
Multicentre, prospective, observational study including 12 hospitals. Consecutive adult inpatients undergoing colonoscopy were evaluated from February through November 2019.
1,302 inpatients underwent colonoscopy. Diagnostic yield for relevant findings and cancer was 586 (45%) and 112 (8.6%), respectively. Adequate colon cleansing was achieved in 896 (68.8%) patients. Split-dose/same-day regimen was adopted in 847 (65%) patients. Factors associated to relevant findings were age ≥70 years (RR 1.32), male gender (RR 1.11), blood loss (RR 1.22) and adequate cleansing (RR 1.63). Age ≥70 years (RR 2.08), no previous colonoscopy (RR 2.69) and split-dose/same-day regimen (RR 1.59) significantly increased cancer detection. Implementing adequate cleansing and split-dose/same-day regimen in all patients would increase the diagnostic yield for any relevant findings and cancer from 43% to 70% and from 6% to 10%, respectively.
Relevant colorectal diseases and cancer were frequent among inpatients. Factors associated with detection of relevant findings were identified. Adequate colon cleansing and split-dose/same-day regimen significantly increased colonoscopy diagnostic yield.
Abbreviations:BBPS (Boston Bowel Preparation Scale), CI (confidence interval), CRC (colorectal cancer), IQR (interquartile range), NNS (number needed to scope), RR (relative risk), SD (standard deviation), STROBE (Strengthening the Reporting of Observational Studies in Epidemiology)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Digestive and Liver Disease
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Patterns of endoscopy in the United States: analysis of data from the centers for medicare and medicaid services and the national endoscopic database.Gastrointest Endosc. 2008; 67: 489-496
- Coronavirus (COVID-19) outbreak: what the department of endoscopy should know.Gastrointest Endosc. 2020;
- Appropriateness of colonoscopy in Europe (EPAGE II). Presentation of methodology, general results, and analysis of complications.Endoscopy. 2009; 41: 240-246
- Appropriate use of GI endoscopy.Gastrointest Endosc. 2012; 75: 1127-1131
- Appropriateness of colonoscopy in Europe (EPAGE II). Iron-deficiency anemia and hematochezia.Endoscopy. 2009; 41: 227-233
- Appropriateness of colonoscopy in Europe (EPAGE II). Functional bowel disorders: pain, constipation and bloating.Endoscopy. 2009; 41: 234-239
- Appropriateness of colonoscopy in Europe (EPAGE II). Chronic diarrhea and known inflammatory bowel disease.Endoscopy. 2009; 41: 218-226
- Indications for colonoscopy. An analysis based on indications and diagnostic yield.S Afr Med J. 1993; 83: 245-248
- Diagnostic yield of open access colonoscopy according to appropriateness.Gastrointest Endosc. 2001; 54: 175-179
- Strategies to address increased demand for colonoscopy: guidelines in an open endoscopy practice.Clin Gastroenterol Hepatol. 2004; 2: 178-182
- The European panel on the appropriateness of gastrointestinal endoscopy guidelines colonoscopy in an open-access endoscopy unit: a prospective study.Aliment Pharmacol Ther. 2005; 21: 609-613
- The diagnostic yield of colonoscopy in patients with isolated abdominal pain.N Z Med J. 2013; 126: 36-44
- European panel on the appropriateness of gastrointestinal endoscopy II guidelines help in selecting and prioritizing patients referred to colonoscopy – a quality control study.Scandinavian J Gastroenterol. 2014; 49: 492-500
- Clinical validation of the European panel on the appropriateness of gastrointestinal endoscopy (EPAGE) II criteria in an open-access unit: a prospective study.Endoscopy. 2012; 44: 32-37
- Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019.Endoscopy. 2019; 51: 775-794
- Modifiable factors associated with quality of bowel preparation among hospitalized patients undergoing colonoscopy.J Hosp Med. 2019; 14: 278-283
- Performance measures for lower gastrointestinal endoscopy: a European society of gastrointestinal endoscopy (ESGE) quality improvement initiative.Endoscopy. 2017; 49: 378-397
- The ASGE guidelines for the appropriate use of colonoscopy in an open access system.Gastrointestinal Endoscopy. 2000; 52: 39-44
- Colonoscopy in nonagenarians is safe and may be associated with clinical benefit.J Am Geriatr Soc. 2019; 67: 1158-1163
- Factors that affect adequacy of colon cleansing for colonoscopy in hospitalized patients.Clin Gastroenterol Hepatol. 2020;
- The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.Lancet. 2007; 370: 1453-1457
- Estimating the relative risk in cohort studies and clinical trials of common outcomes.Am J Epidemiol. 2003; 157: 940-943
- Adjusting for multiple testing–when and how?.J Clin Epidemiol. 2001; 54: 343-349
- Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. multi-society task force on colorectal cancer.Am J Gastroenterol. 2002; 97: 1296-1308
- Adenoma detection rate and risk of colorectal cancer and death.New Eng J Med. 2014; 370: 1298-1306
- Quality indicators for colonoscopy and the risk of interval cancer.New Eng J Med. 2010; 362: 1795-1803
- World endoscopy organization consensus statements on post-colonoscopy and post-imaging colorectal cancer.Gastroenterology. 2018; 155 (.e3): 909-925
- Randomized clinical trial comparing consultant-led or open access investigation for large bowel symptoms.Br J Surg. 2003; 90: 941-947
- Open access colonoscopy: Critical appraisal of indications, quality metrics and outcomes.Dig Liver Dis. 2016; 48: 940-944
- Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424
- Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European panel of appropriateness of gastrointestinal endoscopy European multicenter study.Gastrointest Endosc. 2005; 61: 378-384
- Split-dose preparation for colonoscopy increases adenoma detection rate: a randomised controlled trial in an organised screening programme.Gut. 2017; 66: 270-277
- OC.07.1 Factors influencing the risk of persistent or recurrent bleeding in patients with lower gastrointestinal bleeding: results of a prospective, multicentre, cohort study.Digestive Liver Disease. 2020; 52: S23-S24
- Comparing the real-world effectiveness of competing colonoscopy preparations: results of a prospective trial.Am J Gastroenterol. 2019; 114: 305-314
- Quality of bowel cleansing in hospitalized patients undergoing colonoscopy: a multicentre prospective regional study.Digestive Liver Disease. 2015; 47: 669-674
- Systematic review with meta-analysis: the appropriateness of colonoscopy increases the probability of relevant findings and cancer while reducing unnecessary exams.Aliment Pharmacol Ther. 2020; (. Online ahead of print. https://doi.org/10.1111/apt.16144)
Published online: November 10, 2020
Accepted: October 21, 2020
Received: July 20, 2020
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.