Appropriateness of Colonoscopy Indications in Multiple Digestive Endoscopy Centers in Abidjan: A Multicenter Study Using EPAGE II Criteria
Abstract
Background: Colonoscopy is the reference examination for the lower gastrointestinal tract, yet inappropriate prescribing remains common, exposing patients to procedural risk and increasing costs. The European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE II) provides validated criteria for assessing colonoscopy indications. This study evaluated the appropriateness of colonoscopy indications across multiple endoscopy centers in Abidjan, Côte d’Ivoire, using EPAGE II criteria.
Methods: This prospective, analytical, multicenter study was conducted from January to September 2024 in four endoscopy units (two university hospitals and two private clinics). Adults undergoing diagnostic colonoscopy were enrolled after oral informed consent. Each indication was classified with the EPAGE II online tool as appropriate and necessary, appropriate, uncertain, or inappropriate. Associations were examined using chi-squared and Student t tests.
Results: Of 448 colonoscopies, 419 met the inclusion criteria. The mean age was 52 years, and 61.8% were male. Overall, 57.0% of indications were appropriate, 22.7% inappropriate, and 20.3% uncertain. Appropriateness was significantly higher among gastroenterologists (92.0%) than non-gastroenterologist specialists (42.6%), general practitioners (27.5%), or paramedical staff (7.4%). Inappropriate indications were associated with younger age. Significant lesions, including colorectal cancers and polyps, were detected almost exclusively in patients with appropriate indications.
Conclusion: Fewer than 60% of colonoscopy indications met EPAGE II criteria, and inappropriate referrals were associated with non-specialist prescribers and younger patient age. Routine application of EPAGE II criteria and targeted training of non-specialist prescribers could optimize resource use and reduce avoidable risk in resource-limited settings.
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References
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Copyright (c) 2026 Yaogo Abdoulatif, Aboubacar Demba Bangoura, Nancy Arlene Mesode Ekane Halle, Claver Olivier Kouassi Koffi, Claude Regis Lah Bi, Rebecca Gnininfoun Lofigue, Ange Christelle Amoin Degnon, Nicaise Koffi, Henriette Kissi Anzouan-Kacou, Fulgence Mammert Yao-Bathiax
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