Screening Colonoscopies by Primary Care Physicians: A Meta-Analysis

Abstract

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...

Screening Colonoscopy from a Large Single Center of Thailand - Something Needs to be Changed?

“…There was no significant difference among the three pathological rate of colon cancer screening in the setting of hospital based in Thailand was 30.9% and 16.5% respectively. This data was compatible with the results from previous studies in many countries (Liou et al, 2007;Parente et al, 2009;Wilkins et al, 2009;Strnad and Sonogoric, 2010;Taber et al, 2010;Diamon et al, 2011;Leung, 2011;Long et al, 2011) which reported 25-48% of adenoma detection rate and recommended colon cancer screening in average-risk people over 50 years old. However, it is different from Taiwanese study (Tracy et al, 1976) which stated only 13% of polyp detection rate.…”

“…Colorectal cancer (CRC) is a leading cause of cancer death worldwide (Wilkins et al, 2009). It is the second most common cancer in most Western countries.…”

“…There was evidence that the prevalence and incidence of CRC between Western and Asian population was different. The adenoma detection rate (ADR) were reported to be about 30-40% and 1.7% respectively (Segna et al, 2005;Liou et al, 2007;Sanaka et al, 2009;Wilkins et al, 2009;Taber et al, 2010). The CRC detection rate could be as high as 4% if patients underwent colonoscopy because of positive fecal occult blood test (Segnan et al, 2005).…”

Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

“…In view of the recent implementation of several nationwide screening programs using FIT in Western countries, it is important to address potential factors which may affect performance of these tests, as this knowledge may help to design tailored screening strategies. In our study conducted in subjects with average risk, the adenoma detection rate, one of the quality indicators for colonoscopy, was 26% and is in line with previously published data ranging from 21% to 29% (23)(24)(25). It should be acknowledged that colonoscopy has a miss rate of up to 22% for polyps of any size, as has been reported by a recent meta-analysis of back-to-back colonoscopy studies (26).…”

Colonoscopia: morbidade negligenciada

“…O sangramento após colonoscopia tem relação direta com procedimento diagnóstico como biópsia e terapêutico como polipectomia 1,2,5,6,8,9,11,12 , assim como evidenciado no atual estudo. Este sangramento pode ocorrer durante o procedimento (quatro casos no presente estudo) ou mesmo depois de dias 2,7,8,9,11 (um caso) e tem maior incidência quanto maior o pólipo ressecado ou sua característica séssil 1,6 . A perfuração apesar de menos prevalente, apresenta elevado risco ao paciente, podendo ser letal.…”