ABSTRACT
PURPOSE: Flexible sigmoidoscopy (FS) is considered an adequate screening test in average risk (AR) patients. The purpose of this study was to determine the diagnostic yield of FS in detecting colonic neoplasia between AR and high risk (HR) patients. METHODS: We present a chart review of 559 outpatient colonoscopies performed by a family physician from September 2003 to October 2007. The prevalence of neoplasia and diagnostic yield of FS was compared between groups. RESULTS: The overall prevalence of neoplasia was 23.1% (AR) and 32.8% (HR); p = 0.02. The prevalence of proximal neoplasia not detectable by FS was 10.2% (AR) and 14.5% (HR); p = 0.16. The diagnostic yield of FS in each group was 56%; FS would have missed 44% of polyps regardless of patient risk. CONCLUSIONS: The high rate of colonic neoplasia not detected by FS (44%) suggests that FS alone is inadequate for screening in AR patients.
Subject(s)
Colonic Neoplasms/diagnosis , Military Personnel , Physicians, Family , Sigmoidoscopy , Colonic Neoplasms/epidemiology , Female , Humans , Male , Middle Aged , Practice Guidelines as Topic , Prevalence , Washington/epidemiologyABSTRACT
PURPOSE: Training numbers for colonoscopy vary among specialties. Tracking colonoscopy quality indicators for program graduates may provide reliable outcome data to improve educational programs and establish training requirements. The purpose of this study was to measure specific colonoscopy quality indicators for a family medicine graduate to determine if outcome can be used to assess the quality of procedure training and contribute to more objective means of establishing training numbers. METHODS: We present a case series of the first 800 colonoscopies performed by a newly credentialed family physician who had performed 101 procedures during residency training. Procedure reports and medical records were reviewed for all patients receiving a colonoscopy by this physician from September 2003 to September 2007. Selected quality indicators were compared to recommended colonoscopy standards. RESULTS: The overall reach-the-cecum rate was 98.6%. Adenomas were detected in 21.6% of females and 33.7% of males. All polyps measuring less than 2 cm were removed. Epinephrine was used for 3 patients with hemostasis after polypectomy. There were no perforations. CONCLUSIONS: Quality indicators for colonoscopy were met after 101 supervised procedures. Postgraduate tracking of nationally recognized colonoscopy quality indicators can provide valuable outcome data to improve residency training and assist in establishing uniform training requirements among specialties.
