Colonoscopy performed by a family physician. A case series of 751 procedures.
BACKGROUND
Colonoscopy, including biopsy and polypectomy, is a procedure not commonly performed by primary care physicians. The purpose of this research was to present a large case series of colonoscopic procedures performed by a family physician in a rural practice.


METHODS
A chart review of every colonoscopy procedure performed by a family physician over a 7-year period determined the demographic characteristics, indications, findings, and complications for each procedure.


RESULTS
A total of 751 colonoscopies were performed on 555 patients (347 women and 208 men), with a mean age of 53.8 years. In 91.5% of procedures, the cecum was intubated. The most common indications for colonoscopy were bleeding (49.9%), polyp follow-up (20.9%) abdominal pain (11.7%), diarrhea (11.6%), and abnormal findings on flexible sigmoidoscopy (8.4%). Three hundred sixteen benign polyps were discovered and removed by either biopsy or polypectomy. There were 184 adenomatous colorectal polyps found in 134 (17.8%) colonoscopies. Of these 184 adenomatous polyps, 106 (58%) were potentially within reach of the flexible sigmoidoscope. Only three adenocarcinomas were discovered during the entire study period. There was only one major procedural complication: a patient experienced blood oozing from a polypectomy stump; cautery stopped the bleeding, and the patient was hospitalized overnight, with no further intervention or transfusion required. There were five other self-limited complications, including adverse reactions to sedation and infiltration at the intravenous site.


CONCLUSIONS
Colonoscopy with polypectomy that was safely and competently performed in a solo rural practice adds to the evidence that experienced family physicians can provide this important service to their community.
Pierzchajlo
R P
RP
Department of Family and Community Medicine, Mercer University School of Medicine, Macon, Georgia, USA.
Ackermann
R J
RJ
Vogel
R L
RL
D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D003111:Colonic Polyps / Q000175:diagnosis / Q000601:surgery; D003113:Colonoscopy / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000193:education / Q000592:standards; D011331:Private Practice; D012189:Retrospective Studies; D012423:Rural Health