Gastroenterologists utilize the referral for EGD to enhance colon cancer screening more effectively than primary care physicians.
BACKGROUND
Colorectal cancer screening rates among patients with upper gastrointestinal symptoms undergoing oesophagogastroduodenoscopy have not been previously established. We hypothesize that gastroenterologists seize this opportunity more frequently than primary care providers.


OBJECTIVE
To assess colorectal cancer screening rates at the time of direct access oesophagogastroduodenoscopy and gastrointestinal clinic evaluation for upper gastrointestinal symptoms. To compare rates in the 6 months following the oesophagogastroduodenoscopy in both cohorts of patients.


METHODS
Retrospective review. primary care physician group: direct access oesophagogastroduodenoscopy (n = 247) vs. gastrointestinal group (n = 278). Multivariable regression analysis utilized to assess predictors of screening outcome.


RESULTS
Colorectal cancer screening at the time of referral was 54%. Among the 243 unscreened patients, an additional 29% in the primary care physician group vs. 59% in the gastrointestinal group completed colorectal cancer screening in 6 months of follow-up. Nearly 60% patients evaluated in gastrointestinal clinic for upper symptoms had documented discussion, and 99% of those patients underwent colonoscopy (P < 0.001). Gastrointestinal consultation increased the probability of colorectal cancer screening completion eightfold (95% CI 3.69-18.96).


CONCLUSIONS
At the time of evaluation for upper symptoms, half of patients were not current with colorectal cancer screening recommendations. Referrals for the direct access oesophagogastroduodenoscopy and, more importantly, the gastroenterology consult represent key opportunities for colorectal cancer screening education and improved compliance.
Division of Gastroenterology, University of Michigan, Ann Arbor, 48109, USA. sbartnik@umich.edu
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Menees
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Scheiman
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Carlos
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Mulder
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Fendrick
D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004384:Duodenoscopy / Q000379:methods; D016145:Endoscopy, Digestive System / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005773:Gastroscopy / Q000379:methods; D006304:Health Status; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods; D012017:Referral and Consultation; D012189:Retrospective Studies; D012737:Sex Factors