PURPOSE There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in fi lling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectiveness of colonoscopies performed by primary care physicians.
METHODSWe identifi ed relevant articles through searches of MEDLINE and EMBASE bibliographic databases to December 2007 and through manual searches of bibliographies of each citation. We found 590 articles, 12 of which met inclusion criteria. Two authors independently abstracted data on study and patient characteristics. Descriptive statistics were performed. For each outcome measure, a random effects model was used to determine estimated means and confi dence intervals.
RESULTSWe analyzed 12 studies of colonoscopies performed by primary care physicians, which included 18,292 patients (mean age 59 years, 50.5% women). The mean estimated adenoma and adenocarcinoma detection rates were 28.9% (95% confi dence interval [CI], 20.4%-39.3%) and 1.7% (95% CI, 0.9%-3.0%), respectively. The mean estimated reach-the-cecum rate was 89.2% (95% CI, 80.1%-94.4%). The major complication rate was 0.04% (95% CI, 0.01%-0.07%); no deaths were reported.CONCLUSIONS Colonoscopies performed by primary care physicians have quality, safety, and effi cacy indicators that are comparable to those recommended by the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Based on these results, colonoscopy screening by primary care physicians appears to be safe and effective. Ann Fam Med 2009;7:56-62. DOI: 10.1370/afm.939.
INTRODUCTION
C olorectal cancer1-4 is the third most common cancer and second leading cause of cancer mortality in the United States.5 Guidelines recommend colonoscopy as a suitable screening method, 1,4,6,7 and evidence is increasing that colonoscopy may be the most cost-effective approach. 3,[8][9][10][11][12][13][14] As a result, the demand for screening colonoscopy is rapidly growing. The resources needed to screen every eligible person using colonoscopy do not currently exist in the US medical system, however, 15 and fewer than one-third of those who are eligible for colonoscopy are screened. 3,16 There has been a recent call for monitoring quality indicators in endoscopy to support continuous quality improvement among endoscopists. Proposed measures for quality include reach-the-cecum rates, adenoma detection rates, advanced adenoma detection rates, and withdrawal times. 14,17,18 In the United States, a comprehensive task force of the American Society of Gastrointestinal Endoscopists and the American College of Gastroenterology has recommended acceptable standards for these qual- 19 In the United Kingdom, the Joint Advisory Group on GI Endoscopy (JAG) established standards for colonoscopies regardless of specialty. These standards state t...
