Colonoscopy by a family physician: a 9-year experience of 1048 procedures.
BACKGROUND
In the last 15 years, family physicians and general internists have adopted flexible fiberoptic endoscopy as a procedure to screen patients at risk of premature death from colorectal cancer. There has been controversy regarding the ability of non-fellowship-trained primary care physicians to extend this experience to full colonoscopy.


METHODS
The results of 1048 consecutive colonoscopy examinations performed by a family physician over a 9-year period were tabulated. Outcomes measured included the reach-the-cecum rate (RCR), use of medication, complication rate, and diagnostic yield. In a convenience sample of 110 cases, the effectiveness of the non-narcotic analgesic ketorolac was assessed by the RCR. Outcomes of cases in which ketorolac was used were compared with cases in which traditional sedation and analgesia were used.


RESULTS
A high diagnostic yield without significant complications was noted. The RCR for nonmedicated patients was 36%. Among all medicated cases, the RCR was 93%. In patients who were given the non-narcotic analgesic ketorolac, the RCR was 96%, compared with 95% in patients not given ketorolac.


CONCLUSIONS
A family physician in rural practice was able to attain and sustain a state-of-the-art, reach-the-cecum rate over a 9-year period. This service resulted in a high diagnostic yield, high degree of safety, and satisfactory results for the community. Ketorolac is an effective alternative for patients who may be hypersensitive to narcotic analgesia/sedation.
Hopper
W
W
North Coast Faculty Medical Group Association, Santa Rosa, California, USA.
Kyker
K A
KA
Rodney
W M
WM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002432:Cecum; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D004338:Drug Combinations; D005069:Evaluation Studies as Topic; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D020910:Ketorolac; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D014046:Tolmetin / Q000008:administration & dosage / Q000031:analogs & derivatives
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D008614:Meperidine; D014046:Tolmetin; D008874:Midazolam; D020910:Ketorolac