Appropriateness of Colonoscopy: Inflammatory Bowel Disease 1

Introduction The use of colonoscopy to diagnose and follow up patients with inflammatory bowel disease is widely accepted. However, there is considerable uncertainty as to when colonoscopy is appropriate with respect to clinical symptoms, response to treatment and results of previous investigations. Uncertainty is even more important regarding the most appropriate use of colonoscopy in cancer screening in IBD. In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [ 1 ], and of the whole process, as well as the global results of the panel [ 2 ], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing. This article presents the literature review on IBD that was provided to the panelists for study and comment prior to the panel to support their ratings of appropriateness of colonoscopy in IBD. In addition, an overview of the main panel results related to IBD and a summary of published evidence and panel based appropriateness criteria are presented. 1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)