Colonoscopy: why are general surgeons being excluded?

Mehran, Amir; Jaffe, Philip E.; Efron, Jonathan E.; Vernava, Anthony M.; Liberman, M. A.

doi:10.1007/s00464-003-8806-5

Cited by 33 publications

(25 citation statements)

References 4 publications

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“…As principais complicações em polipectomia com alça diatérmica são sangramento, perfuração e dor abdominal 14,15 e estão associadas ao tamanho do pólipo 7,16,17,18,19,20 e são aqui demonstradas nas Tabelas 1, 2, 3 e 4. O tratamento destas complicações, em colonoscopia terapêutica, costuma ser por via endoscópica para hemorragia e conservador, não cirúrgico, para perfuração [21][22] .…”

Section: Discussionunclassified

Colonoscopia com polipectomia: análise crítica de fatores de risco e complicações

Silva

Pelosi²,

Freitas³

et al. 2009

Rev bras. colo-proctol.

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Tratalho realizado no Serviço de Coloproctologia do HSE-RJ e no Serviço de Endoscopia Digestiva da Casa de Portugal -RJ. Recebido em 19/03/2009 Aceito para publicação em 28/04/2009 INTRODUÇÃOAdenoma é precursor do câncer colorretal 1-2 e a sua remoção serve como prevenção 3,4,5,6 . A intenção deste estudo é de avaliar os efeitos adversos da polipectomia realizada com alça diatérmica. PACIENTES E MÉTODOSAnalisamos de forma retrospectiva 1687 polipectomias com alça diatérmica realizadas em 8447 colonoscopias em duas instituições médicas no período de 2001 a 2007. Duzentos e três pólipos eram maiores do que 2 cm de diâmetro. Teste t de Student foi utilizado para análise de média e desvio padrão e qui-quadrado para números absolutos. P < que 0,05 foi considerado significante. As grandes lesões sésseis foram abordadas por técnica combinada, isto é, polipectomia convencional com alça diatérmica complementada por mucosectomia para retirada completa e segura das margens. Não abordamos neste estudo ressecções de lesões planas ou plana-elevadas por mucosectomia. RESULTADOSEm 1687 polipectomias, 203 foram para pólipos maiores do que 2 cm, considerados grandes, sendo que o maior deles tinha10 cm de diâmetro.A tabela 1 mostra a incidência de sangramento imediato quando comparamos o tamanho dos pólipos.Sangramento tardio, aquele que ocorreu após 24 h do procedimento pode ser visto na tabela 2.

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Section: Discussionunclassified

Colonoscopia com polipectomia: análise crítica de fatores de risco e complicações

Silva

Pelosi²,

Freitas³

et al. 2009

Rev bras. colo-proctol.

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“…The authors emphasized the importance of designing endoscopy units in a way that both surgeons and gastroenterologists could work in a symbiotic environment, not as centers to be only used by gastroenterologists. In addition, distinctions are being made particularly in colonoscopy applications such as gastroenterologists and non-gastroenterologists in an attempt to create a perception that surgeons should not perform endoscopic procedures (26). However, in their colonoscopy series of 5237 cases, Mehran et al (26) showed that general surgeons were as successful as gastroenterologists and colorectal surgeons in terms of complication and cecal intubation rates.…”

Section: The Role Of Surgeons In Endoscopic Applicationsmentioning

confidence: 99%

“…In addition, distinctions are being made particularly in colonoscopy applications such as gastroenterologists and non-gastroenterologists in an attempt to create a perception that surgeons should not perform endoscopic procedures (26). However, in their colonoscopy series of 5237 cases, Mehran et al (26) showed that general surgeons were as successful as gastroenterologists and colorectal surgeons in terms of complication and cecal intubation rates. A study by Bielawska et al (27) showed that the risk of perforation during colonoscopy was twice as high with non-gastroenterologists than with gastroenterologists.…”

Section: The Role Of Surgeons In Endoscopic Applicationsmentioning

confidence: 99%

The role of surgeons on the development and performance of endoscopy

Dolay

Hasbahçeci

2017

Turk J Surg

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1Endoscopy is being frequently performed for both diagnostic and therapeutic applications in surgical practice. Surgery, as a scientific area, has an important role in the propagation of therapeutic endoscopic procedures. The contribution of surgeons to the evolution of endoscopic applications and its practice is a triggering factor for the improvement of endoscopic instruments and their widespread use.Training and education on basic diagnostic and therapeutic surgical endoscopy should be implemented as part of general surgery residency core program, according to accepted standardized criteria, in order for general surgeons to perform endoscopic applications in the future.In light of this information, it can be concluded that endoscopy training and skills should be standardized within accepted general principles. Standards to be used during post-graduate endoscopic practice should be precisely stated. In addition to accreditation of both surgeons and endoscopic centers, theoretical and practical education programs should be composed and organized. for the first time (3-5). Nitze developed the first cystoscopy in 1877 (6). Another general surgeon, Johann von Mikulicz-Radecki, was the first to perform rigid gastroscopy under morphine sedation (7,8). The semi-flexible tube endoscope was first developed and used by Georg Kelling in 1898 (9). Kelling, a surgeon, performed peritoneoscopy (celioscopy) simultaneously with Dimitrij Oscarovic Ott and Hans Christian Jacobeus (10-12). The idea of placing a camera at the end of an endoscope was put into practice by Lange and Meltzing in 1898 (13). Rudolf Schindler developed the semi-flexible endoscopic instruments used by Kelling (3,14). Schindler, along with Wolf, has made semi-flexible endoscopy widely available and is considered the father of gastroscopy. Basil Hirschowitz developed and used the first fiberoptic endoscopy in 1957 (3, 8). In summary, the physicians mentioned above have been the pioneers in the development of today's endoscopy systems. Following improvements in fiberoptic endoscopy systems of the upper gastrointestinal tract, colonoscopy applications for both diagnosis and treatment has gained wide acceptance. THE ROLE OF SURGEONS IN THE EVOLUTION OF ENDOSCOPYSurgeons have been active both in the development of the concept of endoscopy and in its use for different purposes. Philipp Bozzini, the father of endoscopy, Adolf Kussmaul who used sunlight as an artificial light source and known by some authors as the father of gastroenterology, Max Nitze who developed and used cystoscopy, Johann von Mikulicz-Radecki who used rigid gastroscopy for the first time, Dimitrij Oscarovic Ott who performed the first peritoneoscopy with tube endoscopy at the same time with Georg Kelling are all surgeons who demonstratedtheir skills inthe endoscopic area as well (8,15). Kussmaul was the first to use gastric tubes for therapeutic purposes. In addition, Kussmaul performed dilatation of esophageal strictures and drainage of gastric contents in case of gastric outlet obstruction...

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“…Some studies have shown that, compared to patients treated by general surgeons or other specialists, patients who underwent colonoscopy performed by a gastroenterologist were significantly more likely to have polyps detected [7][8][9] and removed 10 and had lower rates of bowel perforation, 11 and colorectal cancer was less likely to develop in these patients. 12 However, other studies have revealed no significant difference in polyp detection 13 or complication rates 14 between gastroenterologists and surgeons, with at least 1 study showing that gastroenterologists have significantly higher total complication rates than surgeons. 13 Despite these findings, little…”

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confidence: 98%

Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study

et al. 2018

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Background: Screening colonoscopy for the detection of colorectal carcinoma is provided by several specialties. Few studies have assessed geographic variation in the delivery of this care. Our objective was to investigate how geographic and socioeconomic factors affect who provides screening colonoscopy in Canada. Methods:This was a population-based cohort of all screening colonoscopy procedures performed at publicly funded Canadian health care facilities (excluding those in Quebec) between April 2008 and March 2015. The main outcome of interest was the proportion of colonoscopy procedures performed by surgeons versus gastroenterologists at the neighbourhood level. Predictors of interest included socioeconomic and geographic variables. We used spatial analysis to evaluate significant clustering of practitioner services and multinomial logistic regression to model predictors. Results:We identified 658 113 screening colonoscopy procedures performed by 1886 providers (1169 surgeons and 717 gastroenterologists) over the study period, of which 353 165 (53.7%) were performed by surgeons. A total of 24.2% of neighbourhoods were located within clusters predominantly served by gastroenterologists, and 19.5% were within surgeon clusters; the remainder were in mixed clusters. Rural neighbourhoods had a significantly increased relative risk of being within a surgeon cluster (relative risk [RR] 5.38, 95% confidence interval [CI] 3.48-8.01) compared to mixed clusters and nearly 100 times higher relative risk of being in a surgeon cluster compared to gastroenterologist clusters (RR 98.95,. Neighbourhoods with the highest socioeconomic status were 1.74 (95% CI 1.14-2.56) times likelier to be in gastroenterologist clusters than in mixed clusters.Interpretation: Surgeons provide a large proportion of colonoscopy procedures in Canada and are essential for access to care, particularly in rural regions. Most Canadians are served relatively equally by surgeons and gastroenterologists. This emphasizes the importance of both specialties to the delivery of colonoscopy care across the country. AbstractResearch OPEN CMAJ OPEN, 6(1) E127

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Colonoscopy: why are general surgeons being excluded?

Abstract: General surgeons perform colonoscopies expeditiously, with as low a morbidity rate and as high a completion rate as their gastroenterology or colorectal surgery colleagues. As the results of this study confirm, general surgeons should not be excluded from endoscopy suites.

Cited by 33 publications

References 4 publications

Colonoscopia com polipectomia: análise crítica de fatores de risco e complicações

Colonoscopia com polipectomia: análise crítica de fatores de risco e complicações

The role of surgeons on the development and performance of endoscopy

Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study

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