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Annotated Bibliography
Family physicians have demonstrated the ability to safely and effectively perform colonoscopy. Increasing numbers of family physicians are trained to perform colonoscopy, with nearly two thousand performing this procedure in communities throughout the United States. With a growing number of patients in need of colon cancer screening, family physicians help meet an important public health need. Studies indicate that family physicians who perform colonoscopy compare favorably with gastroenterologists and general surgeons when observable factors (such as the "reach-the-cecum" rate, the time required to complete the procedure, and the rate of complications) are used to determine technical competency in colonoscopy.
- Clinical Competence in Colonoscopy -- Health and Public Policy Committee, American College of Physicians, Ann Int Med 1987;107:772-774
- Minimal training for competence: "Consensus suggests that a minimum of 50 supervised colonoscopies, including at least 15 with polypectomies, must be done to become competent in the cognitive and technical skills."
- Procedural Skills in Flexible Sigmoidoscopy and Colonoscopy for the Family Physician -- Rodney WM, Primary Care 1988(Mar);15(1):79-91
- Why lower GI Endoscopy should be done by family physicians. Technique descriptions and brief discussion on privileges.
- Teaching Lower Gastrointestinal Endoscopy: A Comparison of Family Medicine And Internal Medicine Residencies -- Crump WJ, Phelps TK. J Am Board Fam Prac 1991;4:1-4
- In SE United States, 100% of FP and 92% of IM residencies provided training in LGIE. FPs supervised by FPs, IMs supervised by GI docs. "A higher percentage of FP residents were perceived as satisfactorily trained."
- Flexible Sigmoidoscopy and the Despecialization of Gastrointestinal Endoscopy: An Environmental Impact Report -- Rodney WM, Cancer 1992;70:1266-1271
- Colonoscopy and polypectomy skills available to many primary care physicians holds great promise for the eradication of premature death from colorectal cancer.
- Who Should Do Colonoscopy? [Letter] -- Rex DK, Fam Pract Res J 1994;2:109-113
- Commenting on FP Res J 1993;13:43-52, Rodney, Dabov & Cronin report on 293 cases. Criticized low cecal intubation rate in early cases.
- Privileges, Credentialing and Liability -- Musallam LS, Primary Care 1995;22(3):491-498
- Discussion on the privileging for GI Endoscopy for family physicians. "…we agree that standards of excellence and the health and safety of our patients must come first." "…colonoscopy is a procedure family physicians can perform safely…"
- Colonoscopy by a Family Physician: A 9-Year Experience of 1048 Procedures -- Hopper W, Kyker KA, Rodney WM, J Fam Prac 1996;43(6):561-566
- High diagnostic yield without significant complications. Reach-the-cecum rate for medicated patients was 95-96% (unmedicated 36%).
- Colonoscopy Experience at a Family Practice Residency: A Comparison to Gastroenterology and General Surgery Services -- Harper MB, Pope JB, Mayeaux EJ, Davis TJ, Myers A, Lirette A, Fam Med 1997;29(8):575-579
- Cecum was intubated in 87% of patients overall. Procedure lengths were comparable. Significantly more cancers were found by family practice service than by either GI or GS. No complications reported for any. 26% of FP residencies are teaching colonoscopy.
- Colonoscopy Performed by a Family Physician: A Case Series of 751 Procedures -- Pierzchajlo RP, Ackermann RJ, Vogel RL, J Fam Pract 1997;44(5):473-480
- Cecum intubated in 91.5% of cases. One complication: bleeding polyp stump required cautery. Three carcinomas discovered.
- Advancing From Flexible Sigmoidoscopy to Colonoscopy in Rural Family Practice -- Carr KW, Worthington JM, Rodney WM, Gentry S, Sellers A, Sizemore J, Tennessee Medicine 1998(Jan):21-26
- Reports on 250 cases. Cecum reached in 84% of cases after fist 100. Five cancers found. No significant complications. Learning curve statistics are presented in 50 case increments. Suggests that a primary care physician familiar with flexible Sigmoidoscopy can learn colonoscopy in around 11 cases while maintaining quality of care.
- Practice Patterns of Rural Texas Physicians Trained in a Full-Service Family Practice Residency Program -- Young RA, Byrd AN, Texas Medicine 1999(Feb);95(2):64-68
- Looking at graduate cohorts from 1970 to 1995, the inclusion of colonoscopy procedures in practice increased from 14 to 42 (p<0.05).
- Confronting Colorectal Cancer: Action Steps for Change -- October 2002 - Proceedings of Dialogue for Action: Increasing Cancer Screening Rates convened by the, Cancer Research Foundation of America (CRFA). Recovered from: http://www.preventcancer.org
- "Previous concerns about risks of primary care providers practicing flexible sigmoidoscopy have proven to be unfounded. There is a need for more health providers, including primary care providers, to be trained to perform colonoscopy. Gastroenterologists, surgeons and primary care providers need to work together collaboratively to define training and competency criteria that are realistic. Flexibility should be promoted in giving primary care providers who have adequate training and experience access to Endoscopy suites.
Colonoscopy
