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POLYPECTOMY AND CECAL INTUBATION RATES IN AN AMBULATORY ENDOSCOPY CLINIC
IC Murray, PJ Pendergast, L Koskova, CS Heck
Intestinal Health Institute, Markham, Ontario
There have been a number of out-of-hospital ambulatory endoscopy clinics (AECs) established in Ontario. One recent study using Ontario data has shown that endoscopies done at AECs were associated with an increased rate of missed cancers than endoscopies done in hospital settings. Another reported that cecal intubation rates were lower in AECs.
The purpose of the current study was to collect data in our AEC to track polypectomy and cecal intubation rates over a two year period. All pathology specimens generated from procedures performed in our AEC from January 2005 to December 2006 were tracked and recorded. Data collected included demographic data and percentage of adenomatous polyps or cancer confirmed from biopsy specimens. Cecal intubation rate was calculated from billing data; E747/Z555 over the study period.
Of the 4854 patients on which procedures were performed the cecal intubation rate was found to be 98.6%. Of the total number of biopsies performed (n=2136, 44%), 28.6% (n=1388) were positive and polyps >4mm in size (2006 data only) were seen in 11.5% of cases. Positive results were found 44% of the time if the patient had previous polyps, 37% if they had a previous cancer, 28% if there was a positive family history, 28% for screening procedures, 26% if the procedure was done because the patient had symptoms and 28% when patients were referred for FOBT positive stool (2006 data only). The 2007 data (on going collection) will be available and included for the conference presentation.
We have shown that in our AEC polypectomy rates and cecal intubation rates were comparable to those reported in the literature. Based on our data, only those with a history of previous polyps, and possibly previous cancer, were at a higher risk than the general screening population of having polyps. Surprisingly, those referred with FOBT positive stool did not have a higher rate of polyp detection. Our data provided evidence that colonoscopy can be performed in AECs as effectively as in the hospital setting. It is recommended that collection of data regarding cecal intubation and polypectomy rates would be useful for all physicians performing these procedures regardless of practice setting.