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Annals of Family Medicine 7:56-62 (2009)
© 2009 Annals of Family Medicine, Inc.
doi: 10.1370/afm.939
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Screening Colonoscopies by Primary Care Physicians: A Meta-Analysis

Thad Wilkins, MD1, Bruce LeClair, MD, MPH1, Mark Smolkin, MS2, Kathy Davies, MLS3, Andria Thomas, PhD1, Marcia L. Taylor, MD, MSCR4 and Scott Strayer, MD, MPH5

1 Department of Family Medicine, Medical College of Georgia, Augusta, Georgia
2 Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia
3 Department of Education and Information Services, Medical College of Georgia, Augusta, Georgia
4 Lexington Medical Center, Lexington, South Carolina
5 Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia

CORRESPONDING AUTHOR: Thad Wilkins, MD, Medical College of Georgia, HB-4031, Augusta, GA 30912, twilkins{at}mcg.edu

PURPOSE 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.

Key Words: Colonoscopy • colorectal cancer • physicians, family • internist • general practitioners • primary care physicians • primary health care • mass screening




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TRACK Comments:

Read all TRACK Comments

Primary Care Colonoscopy can be High Quality Colonoscopy
Michael B. Potter
Annals of Family Medicine, 15 Jan 2009 [Full text]
The quality of the examination is key
Amy E Foxx-Orenstein
Annals of Family Medicine, 15 Jan 2009 [Full text]
Re: The quality of the examination is key
Thad Wilkins
Annals of Family Medicine, 15 Jan 2009 [Full text]
Re: Primary Care Colonoscopy can be High Quality Colonoscopy
Thad Wilkins
Annals of Family Medicine, 15 Jan 2009 [Full text]
Quality Colonoscopy
Douglas K. Rex
Annals of Family Medicine, 19 Jan 2009 [Full text]
Primary Care Endoscopy
Michael Kolber
Annals of Family Medicine, 20 Jan 2009 [Full text]
Response to Dr. Rex's comments
Thad Wilkins, et al.
Annals of Family Medicine, 28 Jan 2009 [Full text]
Invited response to Wilkins study in Annals of Family Medicine
Samir A Shah
Annals of Family Medicine, 3 Feb 2009 [Full text]
Response to the American College of Gastroenterology
Michael B. Harper
Annals of Family Medicine, 11 Feb 2009 [Full text]

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