Background- Colorectal surgeons (CRSs) generally undergo more training in colonoscopy than do general surgeons. In practice, most CRSs do a lower volume than gastroenterologists. Competency has been cited as >90% cecal intubation. Expert endoscopist may reach 95%. Are colonoscopies by CRSs as good as high volumes gastroenterologists in terms of cecal intubation and polyp detection rates?
Aim- To review the 14 year colonoscopy experience of an individual academic colon and rectal surgeon and assess the rate of cecal intubation, cause of any failures, and polyp detection rate.
Methods- A prospectively maintained clinical CRS database was queried, to identify colonoscopy performed by a single CRS between 1995 and 2009. 1392 colonoscopies were reviewed. There were 783 male and 609 female patients. Cecal intubation rate was 94.5% (1316 completed). Polyp detection rate was 26.7% (371 polyps found). Reasons for incomplete colonoscopies include incomplete prep (15 pts), patient anatomy (35 pts), patient intolerance (24 pts) and stricture (3 pts). Of the 783 male patients that underwent colonoscopies, 31 were incomplete (7 patient intolerance, 14 patient anatomy, 3 strictures, and 7 poor preps) while of the 609 women that underwent colonoscopies, 45 incomplete procedures (13 patient intolerance, 24 patient anatomy, 1 stricture, and 7 poor preps). Women had a significantly higher incidence of incomplete colonoscopies versus men (p=0.006). 8 cancers were found and 1 anal cancer was found.
Conclusion- Despite the relatively few number of colonoscopies done compared to expected numbers of a busy gastroenterologist, adenoma detection and intubation rates were excellent and well above national recommendations. A significantly higher rate of incomplete colonoscopies was noted in women which may be due to patient anatomy and intolerance.
Program Number: P380