Indications for lower gastrointestinal endoscopy (excluding population screening)

These guidelines cover indications for lower gastrointestinal endoscopy in all cases except screening for colorectal cancer in the general population and except diagnostic strategies for iron-deficiency anaemia, upper gastrointestinal adenoma, primary sclerosing cholangitis and gastric polyposis in the form of cysts in the gastric fundus.
The focus is on the use of lower gastrointestinal endoscopy for diagnosing neoplasia in all subjects at high risk or very high risk of colorectal cancer, and in specific cases in subjects at average risk of colorectal cancer.
The following issues are addressed:

1. Benefits and indications of lower gastrointestinal endoscopy (total colonoscopy or proctosigmoidoscopy versus non-endoscopic investigation, ultrasonography, CT scan, MRI) to look for neoplasia, in the following clinical situations: isolated gastrointestinal symptoms such as abdominal pain, diarrhoea, constipation; chronic or profuse acute rectal bleeding; endocarditis; diverticulosis; before or after organ transplantation.
2. When colon and/or ileal biopsies are useful.
3. Indications and strategy for lower gastrointestinal endoscopy in the monitoring of chronic inflammatory bowel disease (Crohn's disease and ulcerative colitis).
4. Indications and strategy in the monitoring of asymptomatic individuals at very high risk or high risk of colorectal cancer (other than Crohn's disease and ulcerative colitis).
5. Indications and strategy for endoscopic surveillance after resection of one or more colorectal adenomas (non-transformed adenomas (benign adenomas); transformed adenomas (non-invasive and invasive cancer)).