Colonoscopies performed by primary care physicians result in quality markers and lesion detection rates that compare favorably to those of colonoscopies performed by GI specialists, according to a new study.
In the largest study published on colonoscopies performed by primary care doctors, researchers at the University of South Carolina reviewed data from 10,958 colonoscopies performed on 9,815 patients between October 2002 and November 2007.
Working at an ASC with a trained surgical technician, the 51 primary care physicians in the study searched for and excised polyps during the endoscopes' insertion and removal. In each case they were backed up by gastroenterologists or gastrointestinal surgeons in the event that assistance was needed or complications arose.
The cecal intubation rate for the procedures studied was 98.1%, according to the findings published in the August issue of Medical Care, a journal of the American Public Health Association. The average insertion time was 14.4 minutes (13.2 minutes when polyps were not found and 15.1 when they were), and the average withdrawal time was 10.9 minutes (8 minutes when polyps weren't found and 12.5 when they were). The polyp detection rate was 63.1%, and the incidence rate of adverse events (which included 2 perforations and no deaths) was 0.06%.
The study authors suggest that enlisting qualified primary care physicians to conduct colonoscopies could open the door to expanded patient access to colorectal cancer screenings.
Specialists in the field, however, urge caution and emphasize high-quality results. "The support for screening for colon cancer is undeniable," says David Greenwald, MD, FASGE, an associate professor at Albert Einstein College of Medicine's Montefiore Medical Center in New York, N.Y., and a spokesman for the American Society for Gastrointestinal Endoscopy. "Colonoscopy is an important tool for screening. [But] doing a colonoscopy requires both technical and cognitive training."
GI specialists, he notes, have based their professional careers on achieving those standards. "The issue is not who's performing the colonoscopy," he says, "but whether they're adequately trained and experienced to do it."
David Bernard
