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147 QUALITY ASSURANCE OF 1512 ENDOSCOPIC PROCEDURES PERFORMED BY A RURAL FAMILY PHYSICIAN IN CANADA M Kolber, M Diaz, O Szafran, J Suwal Despite the increasing demands for endoscopic services in Canada, few Family Physicians routinely perform endoscopy. Our goal was to examine the indications and endoscopic findings as well as competency and complication rates for the 1512 endoscopic procedures performed by a rural Family Physician with additional skills training in Gastroenterology. We also quantified the number of patients who required a referral to a tertiary care physician.
Department of Family Medicine, University of Alberta, Edmonton, Alberta
METHODS: Retrospective chart audit of all patients who had an endoscopic procedure performed by the Family Physician from September 24, 1999 to October 27, 2005.
RESULTS: 1512 endoscopic procedures were performed, including 500 gastroscopies, 921 colonoscopies and 91 sigmoidoscopies. Of the 500 gastroscopies performed, the most common indications were abdominal pain (33%), Upper GI bleeding (14%) and GERD (12%). Although many of the gastroscopies were normal (28%), 35% had gastritis or duodenitis, 7% had peptic ulcer disease and 11% had esophagitis. We found 11 (2.2%) new cases of celiac disease and 3 (0.6%) cancers, and removed seven foreign bodies. The most common indications for the 1012 colonoscopies and sigmoidoscopies were colorectal cancer screening (25.9%), abdominal pain (20%), and rectal bleeding (20%). Although the majority of lower GI endoscopies were normal (38%), there were 24 colorectal cancers (2.4%), 60 cases (5.9%) of advanced polyps and 113 cases (11.2%) of adenomatous polyps. Also found were 36 (3.6%) new cases of inflammatory bowel disease, 8 cases of Clostridium difficile and one case of Tb colitis.
Cecal intubation was achieved in 840 out of 921 colonoscopies (91.2%). When corrected for inadequate preparation, equipment problems, and colonic stricturing, the adjusted cecal intubation rate was 94%. There was one perforation in 1012 (0.11%) lower GI procedures and one post polypectomy bleed. Of the 1512 endoscopic procedures performed, a total of 85 patients (5.6%) were referred to a tertiary care centre, the majority for surgical correction of a lesion found on the endoscopic evaluation.
CONCLUSION: Family Physicians adequately trained in Gastrointestinal Medicine can provide safe and competent endoscopic service. Continuing to train Family Physicians in Gastrointestinal Medicine will improve access to gastrointestinal care and appropriate endoscopic evaluations for Canadians in rural settings.