Evolving colonoscopy skills in a rural family practice: the first 293 cases

During the 1980s, many family physicians acquired flexible sigmoidoscopy skills for the early detection and secondary prevention of colorectal cancer. As these skills have matured, some family physicians have advanced from flexible sigmoidoscopy to the performance of colonoscopy. This is a descriptive report of this phenomenon from the private practice of one family physician. The first five years of total colonoscopy experience (293 procedures) were analyzed. No complications were encountered. A learning effect (measured in terms of scope depth and anatomical depth) was present during the first 50 procedures; an improvement in examination depth between the 25th and 50th procedure was present. Previous abdominal surgery had an effect on limiting scope-insertion depths. There were no complications, and among sedated patients, 137/253 (54%) of procedures reached the cecum. Important findings included cancer, polyps, and colitis. Twenty-seven percent (9/34) of important pathological findings were located beyond the reach of the 60 cm sigmoidoscope. This study of full colonoscopy in private family practice suggests it is safe, and the diagnostic yield is substantial. Additional studies by family physicians are needed regarding technique, quality assurance, and patient satisfaction.