In recent years, the indications for diagnostic colonoscopy have increased considerably; however, their prescription must be adjusted by considering the benefit–risk ratio. The EPAGE II criteria (European Panel on the Appropriateness of Gastrointestinal Endoscopy) provide an objective tool to assess the appropriateness of these indications.

The aim of our study was to evaluate the application of these criteria in clinical practice and to identify any potential correlation between the appropriateness of the indication and the endoscopic findings.

This is a retrospective analytical study conducted over a 14 months, from September 2024 to November 2025, within the Department of Hepato-Gastroenterology and Proctology “Medicine B”. It included all patients who underwent colonoscopy with or without intubation of the terminal ileum.

Patients with incomplete colonoscopy or indications not listed in the EPAGE II criteria were excluded.

Collected data included age, sex, medical history, indication, endoscopic findings, and the EPAGE score obtained through the official software (available at video abstract).

Statistical analysis was performed using Jamovi software, with a significance threshold of <0.05. For a more relevant analysis, the categories “appropriate” and “appropriate and necessary” were combined.

A total of 205 patients were included, all of whom underwent a complete ileocolonoscopy. The cohort comprised 112 women (54.6%) and 93 men (45.4%), with a female-to-male ratio of 1.2. The mean age was 51 ± 16.5 years, with 114 patients (55.6%) older than 50 years and 91 patients (44.3%) aged 50 years or younger.

More than half of the patients, 112 (54.6%), had no medical history. 37 patients (18%) had inflammatory bowel disease (including 23 Crohn’s disease [11.2%] and 14 ulcerative colitis [6.8%]), and 14 patients (6.8%) had cardiac disease.

The most frequent indications for colonoscopy were chronic diarrhea in 41 patients (20%), rectal bleeding in 36 patients (17.6%), constipation in 33 patients (16.1%), therapeutic assessment in 25 patients (12.1%), screening in 20 patients (9.8%), iron-deficiency anemia in 19 patients (9.3%), and abdominal pain in 16 patients (7.8%).

According to the EPAGE score, indications were classified as: appropriate and necessary in 90 cases (43.9%), appropriate in 58 cases (28.2%), uncertain in 40 cases (19.5%), and inappropriate in 17 cases (8.3%).

Endoscopic lesions were detected in 90 patients (43.9%), most commonly colonic polyps (27 cases; 13.2%), neoplastic processes (14 cases; 6.8%), and endoscopic recurrence of IBD (10 cases; 4.9%).

Univariate and multivariate analyses showed that constipation and chronic diarrhea were significantly associated with an appropriate EPAGE indication for colonoscopy, with p-values of 0.019 and <.001, respectively.

Age over 50 years was also significantly associated with an appropriate EPAGE II score compared with younger patients (95 [83.3%] vs. 53 [58.2%], p < .001).

Our study demonstrates that the EPAGE II score is a simple and effective tool for determining the appropriateness of colonoscopy indications. It not only allows for a better classification of patients based on their clinical indication but also contributes to improving the cost-effectiveness of endoscopic procedures.