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Colonoscopy Quality Critical Factor to Thorough Exam and Best Colon Cancer Detection
Date:1/13/2009

directly comparing primary care physicians to gastroenterologists for the most important endpoint in colonoscopy, i.e. detection of cancer, indicates that gastroenterologist performance on average is clearly superior to primary care physicians'. According to Dr. Rex, all three population-based studies that have determined miss rates for colorectal cancer during colonoscopy by specialty have found that primary care physicians are more likely than gastroenterologists to miss colorectal cancer during colonoscopy (Rex et al Gastroenterology; 1997: 112:17-23; Bressler et al Gastroenterology 2007; 132:96-102; Singh et al Gastroenterology 2007; 132:A-149).

Dr. Rex noted that the Wilkins study is seriously flawed with regard to the detection rate, since 13,363 (73 percent) of 18,292 colonoscopies are derived from a single study which was not reported in a peer reviewed journal. The colonoscopies from this study should have been excluded because the center employs a gastroenterologist and colorectal surgeon, one of whom is on site full-time to rescue procedures when primary care physicians fail to reach the cecum. Moreover, this center has claimed that primary care physicians have equal success rates in their initial procedures compared to those performed after they are fully trained. This could only be achieved with assistance from the specialist. Since this situation is seldom if ever seen elsewhere in clinical practice, the procedures in this report should have been excluded from the study by Wilkins et al.

An additional concern with the Wilkins study is its claims regarding primary care physicians' success rates in reaching the cecum. The cecum is an anatomical landmark in the colon, and visualizing the cecum is considered a thorough exam. The overall reported rate of 89 percent in this meta-analysis is 6 percent below the recommended threshold for screening colonoscopy by the U.S. Multi-Society Task Force on Colorectal Cancer. "All pub
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SOURCE American College of Gastroenterology
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