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Vol. 45. Issue 1.
Pages 9-17 (January 2022)
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Vol. 45. Issue 1.
Pages 9-17 (January 2022)
Original article
The EPAGE guidelines are not an effective strategy for managing colonoscopies during the COVID-19 pandemic
EPAGE no es una estrategia eficaz para la gestión de colonoscopias durante la pandemia por COVID-19
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Lorena Rodríguez-Alonso
Corresponding author
lorena@bellvitgehospital.cat

Corresponding author.
, Francisco Rodríguez-Moranta, Sandra Maisterra, Josep M. Botargues, Ana Berrozpe, Alexandra Ruíz-Cerulla, Gerard Suris, Blau Camps, Joan B. Gornals, Jordi Guardiola
Servicio de Aparato Digestivo, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
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Figures (1)
Tables (5)
Table 1. Advanced neoplasia risk calculation.
Table 2. Prevalence of colorectal cancer and significant colonic lesion according to risk variables.
Table 3. A) Multivariate analysis for the detection of colorectal cancer and significant colonic lesion adjusted for an order considered appropriate according to EPAGE and faecal haemoglobin concentration.
Table 4. Diagnostic precision parameters of the EPAGE guidelines and of the value of the faecal occult blood test for the diagnosis of colorectal cancer and significant colonic lesion.
Table 5. Comparison of the different management strategies based on the number of patients included, colorectal cancer and significant colonic lesion detected, and number of endoscopies required to detect a lesion.
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Abstract
Introduction

The pandemic caused by the SARS-CoV-2 virus has had a serious impact on the functioning of gastrointestinal endoscopy Units. The Asociación Española de Gastroenterología [Spanish Association of Gastroenterology] (AEG) and the Sociedad Española de Endoscopia Digestiva [Spanish Association of Gastrointestinal Endoscopy] (SEED) have proposed the EPAGE guidelines for managing postponed colonoscopies.

Objective

To evaluate the EPAGE guidelines as a management tool compared to the immunologic faecal occult blood test (iFOBT) and compared to risk score (RS) that combines age, sex and the iFOBT for the detection of colorectal cancer (CRC) and significant bowel disease (SBD).

Methods

A prospective, single-centre study enrolling 743 symptomatic patients referred for a diagnostic colonoscopy. Each order was classified according to the EPAGE guidelines as appropriate, indeterminate or inappropriate. Patients underwent an iFOBT and had their RS calculated.

Results

The iFOBT (P < .001), but not the EPAGE guidelines (P = .742), was an independent predictive factor of risk of CRC. The ROC AUCs for the EPAGE guidelines, the iFOBT and the RS were 0.61 (95%CI 0.49−0.75), 0.95 (0.93−0.97) and 0.90 (0.87−0.93) for CRC, and 0.55 (0.49−0.61), 0.75 (0.69−0.813) and 0.78 (0.73−0.83) for SBD, respectively. The numbers of colonoscopies needed to detect a case of CRC and a case of SBD were 38 and 7 for the EPAGE guidelines, 7 and 2 for the iFOBT, and 19 and 4 for a RS ≥ 5 points, respectively.

Conclusion

The EPAGE guidelines, unlike the iFOBT, is not suitable for screening candidate patients for a diagnostic colonoscopy to detect CRC. The iFOBT, in combination with age and sex, is the most suitable strategy for managing demand for endoscopy in a restricted-access situation.

Keywords:
EPAGE guidelines
Suitability
Prioritization
Colonoscopy
Immunologic faecal occult blood test
Resumen
Introducción

La pandemia producida por el virus SARS-CoV-2 ha generado un grave impacto en el funcionamiento de las unidades de endoscopia digestiva. La AEG-SEED han propuesto la utilización de la guía EPAGE para la gestión de las colonoscopias pospuestas.

Objetivo

Evaluar la guía EPAGE como herramienta de gestión en comparación con el test de sangre oculta en heces inmunológico (TSOHi) y con una calculadora de riesgo (CR), que incluye la edad, el sexo y el TSOHi, para la detección de cáncer colorrectal (CCR) y lesión significativa colónica (LSC).

Métodos

Estudio unicéntrico prospectivo. Se incluyeron 743 pacientes derivados para una colonoscopia diagnóstica. Se clasificó cada solicitud según EPAGE en apropiada, indeterminada e inapropiada. Se les entregó un TSOHi y se calculó el valor de la CR.

Resultados

El TSOHi (P < ,001), pero no EPAGE (P = ,742), fue una variable independiente de riesgo de CCR. El AUC ROC de EPAGE, TSOHi y CR fue: 0,61(IC95% 0,49–0,75), 0,95(0,93–0,97) y 0,90(0,87–0,93) para CCR; y 0,55(0,49–0,61), 0,75(0,69–0,813) y 0,78(0,73–0,83) para LSC, respectivamente. El número necesario de colonoscopias para detectar un CCR y una LSC fue de 38 y 7 para EPAGE, de 7 y 2 para TSOHi, y de 19 y 4 para CR ≥ 5 puntos, respectivamente.

Conclusión

EPAGE, a diferencia del TSOHi, no es adecuado para seleccionar a los pacientes candidatos a colonoscopia diagnóstica para la detección de CCR. El TSOHi, en combinación con la edad y el sexo, es la estrategia más adecuada para gestionar la demanda de endoscopia en un escenario de acceso restrictivo.

Palabras clave:
EPAGE
Adecuación
Priorización
Colonoscopia
Test de sangre oculta en heces

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