Reliability of panel-based guidelines for colonoscopy: an international comparison

Gastrointest Endosc. 1998 Feb;47(2):162-6. doi: 10.1016/s0016-5107(98)70350-5.


Background: This study examined the reliability of explicit guidelines developed using the RAND-UCLA appropriateness method.

Methods: The appropriateness of over 400 indications for colonoscopy was rated by two multispecialty expert panels (United States and Switzerland). A nine-point scale was used, which was consolidated into three categories of appropriateness: appropriate, uncertain, inappropriate. The distribution of appropriateness ratings between the two panels and the intrapanel and interpanel agreement for categories of appropriateness were calculated for all possible indications. Similar statistics were calculated for a series of 577 primary care patients referred for colonoscopy in Switzerland.

Results: Over 80% of all indications (348) could be directly compared. The proportions of indications classified as appropriate, uncertain, or inappropriate were 28.4%, 24.7%, 46.6% and 33.0%, 23.0%, 44.0% for the U.S. and the Swiss panels, respectively. Interpanel agreement was excellent for all the possible indications (kappa value: 0.75) and lower for actual cases (kappa value: 0.51) because of lower agreement for the most frequently encountered indications.

Conclusions: Good agreement between the two sets of criteria was found, pointing to the reliability of the method. Partial disagreement occurred essentially for a few, albeit frequently encountered, indications for use of colonoscopy in cases of uncomplicated lower abdominal pain or constipation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Colonoscopy / standards*
  • Colorectal Neoplasms / diagnosis*
  • Humans
  • Practice Guidelines as Topic / standards*
  • Reproducibility of Results
  • Switzerland
  • United States