A recent study suggests a way to derail the possibilityof too few specialists to meet future demand for colonoscopy: bridge the gap with properly trained primary care physicians. But this scenario raises timely questions, about what constitutes proper training in colonoscopy for primary care physicians and whether capacity for colorectal cancer screening really will fall short of demand.
Authors of a meta-analysis published in January say that adequately trained primary care physicians can perform colonoscopy as safely and effectively as endoscopists and gastroenterologists. The analysis included 12 studies reporting outcomes from 18 292 colonoscopies performed by 73 primary care physicians. Their adenoma and adenocarcinoma detection rates were 28.9% and 1.7%, respectively. They were able to reach the cecum—the anatomical landmark of a complete examination—in 89.2% of procedures. Major complications occurred in 0.04% of the procedures, including 3 perforations. No deaths were reported (Wilkins T el al. Ann Fam Med. 2009;7:56-62).
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Improved training rather than improved technology may help colonoscopists detect polyps and perform complete examinations.
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