Appropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer.

TitleAppropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer.
Publication TypeJournal Article
Year of Publication2009
AuthorsArditi, C, Peytremann-Bridevaux, I, Burnand, B, Eckardt, VF, Bytzer, P, Agréus, L, Dubois, RW, Vader, J-P, Froehlich, F, Pittet, V, S Filliettaz, S, Juillerat, P, Gonvers, J-J
Corporate AuthorsEPAGE II Study Group
Date Published2009 Mar
KeywordsColonoscopy, Colorectal Neoplasms, Europe, Guidelines as Topic, Humans, Randomized Controlled Trials as Topic

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for screening for colorectal cancer (CRC) in asymptomatic individuals without personal history of CRC or polyps, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II.

METHODS: A systematic search of guidelines, systematic reviews, and primary studies regarding colonoscopy for screening for colorectal cancer was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy in these circumstances.

RESULTS: Available evidence for CRC screening comes from small case-controlled studies, with heterogeneous results, and from indirect evidence from randomized controlled trials (RCTs) on fecal occult blood test (FOBT) screening and studies on flexible sigmoidoscopy screening. Most guidelines recommend screening colonoscopy every 10 years starting at age 50 in average-risk individuals. In individuals with a higher risk of CRC due to family history, there is a consensus that it is appropriate to offer screening colonoscopy at

CONCLUSIONS: Despite the lack of evidence based on randomized controlled trials (RCTs), colonoscopy is recommended by most published guidelines and EPAGE II criteria available online (, as a screening option for CRC in individuals at average risk of CRC, and undisputedly as the main screening tool for CRC in individuals at moderate and high risk of CRC.

Alternate URL

Alternate JournalEndoscopy
Citation Key / SERVAL ID2738
PubMed ID19280531


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