Outcomes of 1949 endoscopic procedures: performed by a Canadian rural family physician.
OBJECTIVE
To examine the outcomes of endoscopic procedures performed by a family physician trained in endoscopy.


METHODS
Quality assurance practice audit involving medical chart review.


METHODS
Rural family practice in Peace River, Alta.


METHODS
All patients who had endoscopic procedures performed by a rural family physician during the period September 24, 1999, to May 31, 2007.


METHODS
Type of endoscopic procedure performed, indications for and results of the endoscopies, complication rates, referral to tertiary care physicians, and patient demographic information. Colonoscopy competency was determined by the reach-the-cecum rate and by time for colonoscopy completion.


RESULTS
A total of 1956 endoscopic examinations were performed; complete data were verified for 1949 procedures, including 667 gastroscopies, 1178 colonoscopies, and 104 sigmoidoscopies. Endoscopic findings with gastroscopy included 50 (7.5%) cases of peptic ulcer disease, 17 (2.5%) cases of celiac disease, and 6 (0.9%) cases of upper gastrointestinal cancer; 27 (2.1%) cases of colorectal cancer and 48 (3.7%) new cases of inflammatory bowel disease were discovered with lower gastrointestinal endoscopy. The overall adenoma detection rate was 23.7% for male patients and 15.4% for female patients; for patients 50 years and older, it was 29.8% and 18.0% for male and female patients, respectively. The adjusted reach-the-cecum rate for colonoscopies was 92.3%. There was 1 colonic perforation and 1 postpolypectomy bleed. A total of 123 (6.3%) patients required referral to tertiary care physicians, half for definitive surgical intervention.


CONCLUSIONS
A trained family physician can perform endoscopy competently with findings and complication rates consistent with current quality assurance guidelines for endoscopy.
Kolber
Michael
M
Department of Family Medicine at University of Alberta. mkolber@ualberta.ca
Szafran
Olga
O
Suwal
Juhee
J
Diaz
Mark
M
D000416:Alberta; D000704:Analysis of Variance; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D004724:Endoscopy / Q000193:education; D016099:Endoscopy, Gastrointestinal / Q000379:methods* / Q000706:statistics & numerical data; D005194:Family Practice / Q000193:education* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D020380:Needs Assessment; D010821:Physicians, Family; D012189:Retrospective Studies; D018570:Risk Assessment; D019035:Rural Health Services