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Outcomes of 1949 endoscopic procedures

Performed by a Canadian rural family physician

Olga Szafran, MHSA
Associate Director of the Research Program in the Department of Family Medicine at the University of Alberta. At the time of the study

Juhee Suwal, PhD
Rural researcher in the Department of Family Medicine at the University of Alberta

Mark Diaz
Student at the University of Alberta

Correspondence: Dr M. Kolber, Box 7590, Peace River, AB T8S 1T2; telephone 780 624-2581; fax 780 624-4015; e-mailmkolber{at}ualberta.ca

OBJECTIVE To examine the outcomes of endoscopic procedures performed by a family physician trained in endoscopy.

DESIGN Quality assurance practice audit involving medical chart review.

SETTING Rural family practice in Peace River, Alta.

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

MAIN OUTCOME MEASURES 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.

CONCLUSION A trained family physician can perform endoscopy competently with findings and complication rates consistent with current quality assurance guidelines for endoscopy.

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