Outcomes of 1949 endoscopic procedures: performed by a Canadian rural family physician.

Abstract

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.