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Abstract：
BACKGROUND: 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 (AEG) and the Sociedad Española de Endoscopia Digestiva (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<0.001), but not the EPAGE guidelines (p = 0.742), 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 seven for the EPAGE guidelines, seven and two for the iFOBT, and 19 and four for a RS ≥5 points, respectively.
CONCLUSIONS: 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.
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<0.001), but not the EPAGE guidelines (p = 0.742), 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 seven for the EPAGE guidelines, seven and two for the iFOBT, and 19 and four for a RS ≥5 points, respectively.
CONCLUSIONS: 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.
摘要：
背景：由SARS-CoV-2病毒引起的大流行对胃肠内窥镜检查单元的功能产生了严重影响。胃肠病协会（AEG）和胃肠病协会（SEED）提出了管理延迟结肠镜检查的EPAGE指南。
目的：评估EPAGE指南作为一种管理工具，与免疫粪便潜血试验（iFOBT）进行比较，并与结合年龄的风险评分（RS）进行比较，性别和iFOBT检测结直肠癌(CRC)和显著肠病(SBD)。
方法：前瞻性，单中心研究纳入743例有症状的患者进行诊断性结肠镜检查.每个订单都根据EPAGE指南进行了适当的分类，不确定的或不适当的。患者接受iFOBT并计算其RS。
结果：iFOBT（p<0.001），但不是EPAGE指南（p=0.742），是CRC风险的独立预测因素。EPAGE指南的ROCAUC，iFOBT和RS为0.61（95%CI0.49-0.75），CRC为0.95（0.93-0.97）和0.90（0.87-0.93），和0.55（0.49-0.61），SBD为0.75（0.69-0.813）和0.78（0.73-0.83），分别。对于EPAGE指南，检测CRC病例和SBD病例所需的结肠镜检查数量分别为38和7。iFOBT的七个和两个，RS≥5分，为19分，为4分，分别。
结论：EPAGE指南，与iFOBT不同,不适合筛选候选患者进行诊断性结肠镜检查以检测CRC。iFOBT,结合年龄和性别，是在限制进入的情况下管理内窥镜检查需求的最合适策略。
目的：评估EPAGE指南作为一种管理工具，与免疫粪便潜血试验（iFOBT）进行比较，并与结合年龄的风险评分（RS）进行比较，性别和iFOBT检测结直肠癌(CRC)和显著肠病(SBD)。
方法：前瞻性，单中心研究纳入743例有症状的患者进行诊断性结肠镜检查.每个订单都根据EPAGE指南进行了适当的分类，不确定的或不适当的。患者接受iFOBT并计算其RS。
结果：iFOBT（p<0.001），但不是EPAGE指南（p=0.742），是CRC风险的独立预测因素。EPAGE指南的ROCAUC，iFOBT和RS为0.61（95%CI0.49-0.75），CRC为0.95（0.93-0.97）和0.90（0.87-0.93），和0.55（0.49-0.61），SBD为0.75（0.69-0.813）和0.78（0.73-0.83），分别。对于EPAGE指南，检测CRC病例和SBD病例所需的结肠镜检查数量分别为38和7。iFOBT的七个和两个，RS≥5分，为19分，为4分，分别。
结论：EPAGE指南，与iFOBT不同,不适合筛选候选患者进行诊断性结肠镜检查以检测CRC。iFOBT,结合年龄和性别，是在限制进入的情况下管理内窥镜检查需求的最合适策略。
