COLONOSCOPY BY A FAMILY PHYSICIAN - A 9-YEAR EXPERIENCE OF 1048 PROCEDURES

BACKGROUND. In the last 15 years, family physicians and general intern ists have adopted flexible fiberoptic endoscopy as a procedure to scre en patients at risk of premature death from colorectal cancer. There h as been controversy regarding the ability of non-fellowship-trained pr imary care physicians to extend this experience to full colonoscopy. M ETHODS. The results of 1048 consecutive colonoscopy examinations perfo rmed by a family physician over a 9-year period were tabulated. Outcom es measured included the reach-the-cecum rate (RCR), use of medication , complication rate, and diagnostic yield. In a convenience sample of 110 cases, the effectiveness of the non-narcotic analgesic ketorolac w as assessed by the RCR. Outcomes of cases in which ketorolac was used were compared with cases in which traditional sedation and analgesia w ere used. RESULT. A high diagnostic yield without significant complica tions was noted. The RCR for nonmedicated patients was 36%, Among all medicated cases, the RCR was 93%. In patients who were given the non-n arcotic analgesic ketorolac, the RCR was 96%, compared with 95% in pat ients not given ketorolac. CONCLUSIONS. A family physician in rural pr actice was able to attain and sustain a state-of-the-art, reach-the-ce cum rate over a 9-year period, This service resulted in a high diagnos tic yield, high degree of safety, and satisfactory results for the com munity. Ketorolac is an effective alternative for patients who may be hypersensitive to narcotic analgesia/sedation.