Colonoscopy appropriateness in a libyan hospital: The experience with a modified open-access system

Background and Aim: In the absence of guidelines for referring patients for colonoscopy in the Benghazi Medical Center, the use of a modified open-access system of referral may decrease the rate of inappropriate colonoscopies. This study aimed to assess the impact of modified open-access system of referral on colonoscopy appropriateness using the American Society of Gastrointestinal Endoscopy guidelines as a reference. Subjects and Methods: In this observational, cross-sectional, and retrospective study, all colonoscopies performed in the Benghazi Medical Center during the period from January 1, 2015, to December 31, 2016, were retrospectively studied. Colonoscopy reports were retrieved from the paper-based hospital medical archives. Results: After exclusion of colonoscopy records with inadequate data, only 344 colonoscopies were included in the study. Three hundred and nine (89.8%) colonoscopies were found to be appropriate and 35 (10.2%) were inappropriate. The most common appropriate indication was rectal bleeding (61, 19.7%). Examination results were negative in 135 (39.2%) and positive in 209 (60.75%) colonoscopies. Among colonoscopies with positive findings, the number of colonoscopies with positive relevant findings was 126 (60.3%). Of these, the indication was appropriate in 122 (96.8%) and inappropriate in 4 (3.2%) colonoscopies. Appropriate colonoscopies were significantly more likely to be associated with positive relevant findings (P = 0.0029). Conclusion: Modified open-access system of colonoscopy referral increases the rate of appropriate colonoscopies, even if no definite guidelines for colonoscopy appropriateness are followed, neither by referring physicians nor endoscopists.