• Shahad M AlQahtani, Sulaiman A Alshammari, Reem J Khidir, Maha F AlKhunaizi, and Osama M Abdulqader.
• From the Department of Family & Community Medicine (AlQahtani, Alshammari, Abdulqader), College of Medicine, King Saud University, from the Department of Family & Community Medicine (Alshammari), King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia, from the Department of Paediatrics (Khidir), University of Khartoum, Khartoum, Sudan, and from the Department of Family Medicine (AlKhunaizi), Xi'an Jiaotong University, Shaanxi, China.
• Saudi Med J. 2023 Nov 1; 44 (11): 116711731167-1173.

ObjectivesTo examine the colonoscopy referrals in an open-access system and determine the outcome and factors associated with appropriate referral.MethodsA retrospective study of colonoscopy referrals used patients' medical records at King Khalid University Hospital, Riyadh, Saudi Arabia, during 2020-2022. Fisher's exact or Pearson's Chi-squared test were used for data analysis.ResultsOut of 365 patients, 95.1% were referred from family medicine clinics with a mean age of 56.2±15.7 years. Men account for 53.2% of patients. The most common symptoms were change in bowel habits (35.6%), abdominal pain (30.4%), and anemia (20.1%). A family history of colorectal cancer was positive in 12.1%, while a personal history was positive in 4.4%. Most referrals (86.0%) were appropriate based on the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. However, approximately 89.1% of patients aged ≥45 years had neoplasia and 40.0% had inflammatory bowel disease (p=0.019). The rank of the physicians (p=0.558) or the gender of the patients (p=0.665) did not influence the appropriateness. The inappropriate referrals were lower in patients with neoplasia (1.6%) than in patients with other lesions (p=0.002).ConclusionThe colonoscopy referrals were appropriate. The incidence of neoplasia was higher among those aged ≥45. Low inappropriate referrals and a high neoplasia detection were found based on ASGE guidelines. Future research should involve prospective multicenter referrals from family physicians outside hospitals and investigate patients' hesitancy to proceed with colonoscopy and cost-effectiveness.Copyright: © Saudi Medical Journal.

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