European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE): Conclusion and WWW Site

Background Upper and lower gastrointestinal (GI) endoscopy are safe and accurate procedures which are widely used. Given the increasing need to ensure high quality of care within the current worldwide context of cost containment, appropriate use of diagnostic and therapeutic procedures, such as GI endoscopy, is crucial. Clinical practice guidelines are designed to assist in this task; but they need to be based on well-documented and validated methods. One of the leading approaches is the RAND appropriateness method [ 1 ] [ 2 ] [ 3 ] which combines expert opinion with available scientific evidence. Studies comparing the Swiss and US panel-based criteria for the appropriateness of GI endoscopy have shown that the method is reliable [ 4 ] [ 5 ] . With criteria developed according to this method in 1994, we have assessed both over- and underutilisation of gastroscopy and colonoscopy in prospective studies [ 6 ] [ 7 ] [ 8 ] [ 9 ] . Because no criteria were available to define the appropriate use of gastrointestinal endoscopy on a European level, the aim of the Lausanne conference was to develop criteria of appropriateness and necessity, within a concerted action R&D project, to improve quality of care within the European Community. It should be added, however, that - given the significant differences in health care systems, care resources, mentalities and cultures within Europe - the multinational character of the Lausanne Conference does not preclude the possibility that criteria may be customized to the context of a particular country.