New study supports PCPs performing colonoscopies

Primary care physicians with training in colonoscopy techniques are as effective at finding potentially cancerous polyps in the colon as gastroenterologists are, according to a study published in the August edition of Medical Care.

About 12 million colonoscopies are done each year in the United States, but the American Cancer Society estimates twice that many should be done. PCPs in general get the same fee for the procedure as gastroenterologists--about $250, notes the State newspaper. The actual bill to a patient depends on many variables, including fees for the facility, a pathologist (if polyps are removed) and an anesthetist, and often is $1,000 or more.

"There's a turf war over this, and it's very sad and very frustrating," said Dr. Steven Lloyd, an internist and director the South Carolina Medical Endoscopy Center in Columbia, where primary care physicians are trained to perform the procedure.

For the report, lead researcher Sudha Xirasagar and the rest of the team from the University of Southern California examined records from 10,958 colonoscopies performed by 51 primary care physicians from October 2002 through November 2007 at Lloyd's facility.

The study found that adenoma detection rates (the percentage of times that at least one polyp was found) by primary care physicians at the center averaged 34.6 percent in men and 25.4 percent in women, well above the American Society for Gastrointestinal Endoscopy's (AGSE) quality benchmarks of 25 percent in men and 15 percent in women.

In addition, the local center's average withdrawal time--another indicator of colonoscopy quality--when no polyps were found was eight minutes, well above the AGSE quality recommendation of six minutes.

While Xirasagar is reportedly ready for the GI backlash, Columbia gastroenterologist Dr. March Seabrook told The State, "I do not think that gastroenterologists are the only physicians that can pass a scope around a colon, but I do know that this is what we do every day."

To learn more:
- read the article in The State
- here's the abstract of the study in Medical Care

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