RIO GRANDE, P.R. — Primary care physicians can successfully perform screening colonoscopies and identify patients at increased risk for developing colorectal cancer, according to a review of 559 colonoscopies.
Colonoscopy is the preferred screening method for patients who are at increased risk for developing colorectal cancer, while flexible sigmoidoscopy is considered adequate for average risk individuals, said Dr. Khalid Jaboori of Madigan Army Medical Center in Fort Lewis, Washington.
There aren't enough gastroenterologists to perform screening colonoscopies on all the patients who need them, whether they are at high risk or not, said Dr. Jaboori. Colonoscopy is a safe, cost-effective procedure that allows a full view of the colon and management of the findings, he added.
The researchers reviewed outpatient colonoscopies performed by a family physician between September 2003 and October 2007 on patients aged 26–87 years. The study population included 324 patients at average risk and 235 at high risk. The researchers recorded the location of all neoplasias and calculated the diagnostic yield of a flexible sigmoidoscopy for how many neoplasias would have been found with flexible sigmoidoscopy alone. The neoplasias that would have been detected by flexible sigmoidoscopy alone were defined as those in the left colon or in the distal part of the right colon. Dr. Jaboori presented the results in a poster at the annual meeting of the North American Primary Care Research Group.
Overall, the presence of colonic neoplasia was 23% in the average-risk group and 33% in the high-risk group. There was no significant difference in the prevalence of proximal colonic neoplasia that would have been found by colonoscopy between average-risk (10%) and high-risk patients (15%). Also, isolated advanced lesions on the right side of the colon were identified in four patients (1.2%) in the average-risk group and one patient (0.4%) in the high-risk group, which was not a significant difference.
The diagnostic ability of flexible sigmoidoscopy to detect any neoplasia was similar for the average-risk and high-risk groups (both 56%).
“Approximately 44% of the neoplasias would have been missed in both groups with flexible sigmoidoscopy alone,” Dr. Jaboori said.
The results suggest that primary care residents and physicians should be trained in colonoscopies. “Increasing the pool of competently trained endoscopists will allow more patients to benefit from screening colonoscopy as the standard of care,” the researchers noted.
Dr. Jaboori had no conflicts of interest to report. The views in the study are those of the authors and do not reflect the policy of the U.S. Army, the Department of Defense, or the U.S. government. To watch a video go to www.youtube.com/user/FamilyPracticeNews