Article Figures & Data
Figures
- Figure 1.
Search results and study flow diagram.
a Includes patient compliance with screening, capacity to perform colonoscopy, conscious sedation, patient characteristics, learning effect on the number of procedures, colon cancer treatment, genetics of colon cancer.
- Figure 2.
Forest plot of adenoma detection rates.
- Figure 3.
Forest plot of reach-the-cecum rates.
Tables
Study, Year No. of Colonoscopies No. of Colonoscopists Average Age, y (Range) % Female Setting Study Design Training of Endoscopists a Additional information about this study was provided by the author. Godreau,24 1992 157 1 58 (range not reported) 57.1 US family practice Cohort Endoscopist completed 86 flexible sigmoidoscopies with biopsy then attended a continuing medical education workshop. He was proctored for 13 colonoscopies Rodney et al,25 1993 293 1 67 (range not reported) 60.6 US family practice Cohort Trained in sigmoidoscopy then began performing colonoscopy after 300 sigmoidoscopies Hopper et al,26 1996 1,048 1 57 (14–91) 41.3 US family practice Cohort Completed a didactic course Harper et al,27 1997 309 2 Not reported Not reported US family practice Case-control One endoscopist “trained” by gastroenterologist and general surgeon and other endoscopist “trained” by general surgeon and family physician Pierzchajio et al,28 1997 751 1 53.8 (range not reported) 62.5 US family practice Cohort Completed 700 flexible sigmoidoscopies then attended a didactic course on colonoscopy. Carr et al,29 1998 250 1 67.4 (range not reported) 61.6 US family practice Cohort He was precepted for 80 colonoscopies Kirby,30 2004 616 1 58 (range not reported) Not reported Canadian general practitioner Cohort Attended colonoscopy continuing medical education course then completed 11 proctored colonoscopies with 5 polypectomies. Proctored by a family physician Edwards and Norris,31 2004 200 4 62 (16–90) 45.5 US family practice Cohort Completed 30 supervised colonoscopies as part of a general surgery residency training program Newman et al,32 2005 731 2 62.7 (20–92) 51.6 U.S. family practice Cohort Three physicians were trained in family medicine residency programs. One of these physicians proctored the oldest physician until he was proficient in colonoscopy. Strayer,33 2005a 250 4 57.1 (range not reported) 50.4 US family practice Cohort Trained in a family medicine residency program. Attended a continuing medical education course. Proctored by a gastroenterologist Cotterill et al,34 2005 324 2 Not reported Not reported Canadian family practice Cohort All physicians trained in flexible sigmoidoscopy during family medicine residency. One physician proctored in colonoscopy by general surgeon. This physician trained the other physicians in colonoscopy Lloyd,35 2006a 13,363 53 Not reported Not reported US multispecialty primary care endoscopy center Cohort One physician was trained in residency program. Training was not reported for the other physician Total 18,292 73 59 50.5 Training was variable. Physicians proctored by a variety of specialists to include family physicians, internists, general surgeons, gastroenterologists Study, Year Estimated Adenoma Detection Rate (95% CI) Estimated Adenocarcinoma Detection Rate (95% CI) Estimated Reach-the-Cecum Rate (All Patients) (95% CI) Perforationsa Bleeding Not Requiring Transfusiona CI=confidence intervals. Note: rates and 95% CIs calculated using random effect model. a Raw data shown. b Additional information about this study was provided by the author. Godreau,24 1992 51.7 (44.0– 59.3) 2.2 (0.9– 5.7) 83.2 (76.6– 88.2) 0 0 Rodney et al,25 1993 8.8 (6.1– 12.5) 2.0 (0.9– 4.2) 48.7 (43.1– 54.4) 0 0 Hopper et al,26 1996 43.7 (40.7– 46.7) Not reported 74.8 (72.1– 77.3) 0 0 Harper et al27, 1997 20.9 (16.8– 25.8) 3.5 (2.0– 6.1) 87.1 (82.9– 90.4) 0 0 Pierzchajio et al,28 1997 24.7 (21.7– 27.9) 0.6 (0.3– 1.4) 91.4 (89.2– 93.2) 0 0 Carr et al,29 1998 33.4 (27.9– 39.5) 1.9 (0.8– 4.2) 82.2 (77.0– 86.4) 0 1 Kirby,30 2004 16.8 (14.0– 19.9) 2.3 (1.4– 3.8) 80.1 (76.8– 83.1) 0 0 Edwards and Norris,31 2004 22.8 (17.6– 29.0) 2.3 (1.0– 5.2) 96.1 (92.4– 98.0) 0 0 Newman et al,32 2005 32.5 (29.2– 36.0) 0.9 (0.5– 1.9) 92.7 (90.6– 94.4) 0 1 Strayer,33 2005b 51.3 (45.1– 57.3) 0.8 (0.3– 2.6) 94.6 (91.1– 96.7) 0 0 Cotterill et al,34 2005 23.9 (19.6– 28.8) 0.7 (0.2– 2.2) 94.0 (90.9– 96.1) 0 0 Lloyd,35 2006b 38.0 (37.2– 38.8) 5.0 (4.6– 5.4) 98.4 (98.2– 98.6) 3 2 Total 28.9 (20.4– 39.3) 1.7 (0.9– 3.0) 89.2 (80.1– 94.4) 3 4
Supplemental Appendix
Supplemental Appendix. Search Terms
Files in this Data Supplement:
- Supplmental data: Appendix - PDF file, 1 page, 105 KB
Supplemental Figures
Supplemental Figure 1. Funnel plot for adenoma detection rates; Figure 2. Funnel plot for adenocarcinoma detection rates; Figure 3. Funnel plot for reach-the-cecum rates.
Files in this Data Supplement:
- Supplemental data: Figures 1-3 - PDF file, 3 pages, 114 KB
The Article in Brief
Screening Colonoscopies by Primary Care Physicians: A Meta-Analysis
Thad Wilkins , and colleagues
Background Colonoscopy is recommended as a method for screening patients for colorectal cancer. In the US, however, there are not enough clinicians trained in providing colonoscopies to implement a full-scale national screening program. This study systematically examines existing data on the quality and safety of screening colonoscopies performed by primary care doctors.
What This Study Found Colonoscopies performed by trained primary care doctors are safe and effective. They compare favorably in terms of quality to colonoscopies performed by specialists, according to published standards and reports of specialist practice.
Implications
- Primary care doctors trained in colonoscopy can play an important role in providing access to colonoscopy for colorectal cancer screening.
Correction to Table 2
In Table 2, the Estimated Adenocarcinoma Detection Rate (95% CI) for the Lloyd, 2006 entry is incorrect and should read: 0.5 (0.46-0.54).
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