title: Screening colonoscopies by primary care physicians: a meta-analysis.
abstract: OBJECTIVE
  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 filling 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.
  
  
  METHODS
  We identified 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 confidence intervals.
  
  
  RESULTS
  We 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% confidence 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 efficacy 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.
authors.affiliation: Department of Family Medicine, Medical College of Georgia, Augusta, Georgia 30912, USA. twilkins@mcg.edu
authors.forename: Thad
authors.initials: T
authors.lastname: Wilkins
authors.forename: Bruce
authors.initials: B
authors.lastname: LeClair
authors.forename: Mark
authors.initials: M
authors.lastname: Smolkin
authors.forename: Kathy
authors.initials: K
authors.lastname: Davies
authors.forename: Andria
authors.initials: A
authors.lastname: Thomas
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Taylor
authors.forename: Scott
authors.initials: S
authors.lastname: Strayer
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*