Screening colonoscopies by primary care physicians: a meta-analysis.

Area of Science:

• Gastroenterology
• Primary Care Medicine
• Public Health

Background:

• Shortage of endoscopists limits national colorectal cancer screening programs.
• Primary care physicians (PCPs) can potentially fill this gap by performing screening colonoscopies.
• Evaluating the safety and effectiveness of PCP-performed colonoscopies is crucial.

Purpose of the Study:

• To examine the safety and effectiveness of colonoscopies performed by primary care physicians.
• To assess if PCPs meet established quality indicators for colonoscopy.

Main Methods:

• Systematic review of 12 studies including 18,292 patients.
• Data abstracted independently by two authors.
• Random effects models used for statistical analysis.

Main Results:

• Adenoma detection rate: 28.9% (CI, 20.4%-39.3%).
• Adenocarcinoma detection rate: 1.7% (CI, 0.9%-3.0%).
• Cecal intubation rate: 89.2% (CI, 80.1%-94.4%).
• Major complication rate: 0.04% (CI, 0.01%-0.07%); no deaths.

Conclusions:

• PCP-performed colonoscopies demonstrate comparable quality, safety, and efficacy to specialist standards.
• Colonoscopy screening by PCPs is a safe and effective strategy.
• PCPs can play a vital role in expanding colorectal cancer screening access.