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Direct access colonoscopy in primary care centres 'safe and feasible'

Direct access colonoscopy (DAC) services, which see GPs refer patients directly for investigation instead of first referring them to a consultant, are ‘safe and feasible’ in primary care, say UK researchers.

The study

The team, led by Dr Jamil Ahmed at University Hospital Ayr, studied consecutive patients undergoing direct access colonoscopy (DAC) or conventional colonoscopy (CC) at one NHS trust between January 2007 and December 2008. The researchers analysed a total of 3,468 eligible colonoscopies over the two-year period -1,189 performed via DAC and 2,279 via CC. Patients with suspected colorectal cancer, who were ineligible for DAC, were excluded from the study. Safety and feasibility of DAC was analysed against CC, with both groups being compared for findings at colonoscopy, procedural outcomes and complications.

The results

The rate of negative colonoscopy was similar between the groups, with no abnormality detected in 409 (34.3%) patients in the DAC group and 825 (36.2%) in the CC group. The cancer detection rate was also similar, with 39 (3.2%) patients diagnosed with colorectal cancer with DAC, and 68 (2.9%) with CC.

However, more colonic polyps greater than 1cm in size were detected in the CC group, at 518 (22.7%) compared with 150 (12.6%) in the DAC group.

The colonoscopy completion rate was higher in the DAC group than in the CC group, at 88% versus 85%.

The rate of major complications was low and comparable between the two groups. The most commonly reported complication was bleeding, secondary to polyp removal, occurring in three (0.3%) of the DAC patients and four (0.2%) of the CC patients. Five of these patients were treated conservatively, while one patient from each group required haemostasis via endoscopic intervention. Bowel perforation occurred in three (0.3%) patients in the DAC group and two (0.1%) in the CC group; two of the DAC patients were treated conservatively and the rest surgically.

What this means for GPs

The researchers concluded that ‘the safety profile of DAC is comparable to CC service’ but that ‘the comparable diagnostic yield of [the] DAC approach despite relatively lower polyp detection rate needs further investigation’.

They added: ‘Large prospective studies are required to confirm the findings of this study before the role of the DAC is fully established.’

Scottish Medical Journal, online August 2013

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