ASGE Guidelines for Colonoscopy: A Study of Appropriateness and Usefulness Comparing a Gastroenterology Training Program, a General Surgery Residency Program, and a Gastroenterology Private Practice

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Colonoscopy is a widely available diagnostic and therapeutic modality. Besides Gastroenterologists and Surgeons, other physicians including Internists and Family Physicians are also performing Colonoscopy. However, changing trends in medicine to more cost effective practice have made it important to place greater emphasis on appropriateness and usefulness. The ASGE has published guidelines for appropriate use of Colonoscopy. Aim: To compare a Gastroenterology Fellowship Program (GFP), a Surgery Residency (GSR), and a Private Gastroenterology Practice (PGP) with regards to adherence to ASGE guidelines and relevance. Methods: Three hundred records of patients who underwent Colonoscopy were evaluated retrospectively. The indications for Colonoscopy was classified as indicated or not indicated according to the ASGE guidelines. Colonoscopies not indicated were further classified as relevant, if a change in management was probable based on findings, or not relevant, if no change in management was probable. Results: Group N Indicated Not Ind. Relevant Not Relevant GFP 100 84 16* 10/16(63%)** 6/16(37%) GSR 100 59 41 8/41 (24%) 33/41 (76%) PGP 100 92 8* 4/8 (50%)# 4/8 (50%) Total 300 235 (78%) 65 (22%) 22/65 (34%) 43/65 (66%) *P<001 vs GSR, **P< .002 vs GSR, # P=.067 vs GSR. not significant vs GFP Conclusions: Overall there was a high rate of inappropriate use of Colonoscopy. The rate of inappropriate use of Colonoscopy was highest in the General Surgery group, along with lowest rate of relevant findings. Gastroenterology Fellowship Program also had a high rate of inappropriate usage but relevant findings were not significantly different from Private Gastroenterology Practice. Appropriate use of Colonoscopy could be improved in all study groups. The ASGE guidelines could be more strictly adhered.