Endoscopy in primary care--a survey of current practice.

BACKGROUND

Long waiting lists in district general hospitals and savings from fundholding led to the setting up of a number of endoscopy units in primary care. Concerns have been expressed over safety, supervision and cost effectiveness. Increasingly, general practitioners (GPs) are being encouraged to become specialists and offer intermediate care. Endoscopy is frequently cited as an example of intermediate care that could be offered by primary care specialists. This is the first survey of such a service.

AIM: To examine whether endoscopy in primary care can be considered to be a safe procedure.

DESIGN OF STUDY: A questionnaire-based survey.

SETTING

Twenty-eight general practice units performing endoscopy in primary care.

METHOD: Units performing endoscopy in primary care were identified using the Primary Care Society of Gastroenterology (PCSG) database and following an appeal in the GP press. A postal questionnaire was sent to each unit covering its history, throughput, and case-mix, experience of endoscopists, supervision, audit and CME, equipment, waiting times and complication rates.

RESULTS

Of the 28 units identified, 27 (96%) replied to the questionnaire, 13 units provided both upper and lower bowel examination, six oesophago-gastro-duodenoscopy (OGD) only, and eight lower bowel only. Units had been openfor an average of five years (range = 2 to 18 years), and 41 doctors and 68 nurse assistants provided the service. The average experience of endoscopists was 16 years (range = 6 to 25 years), and 36,455 procedures had been performed by the time of the survey (24,195 OGD and 12,260 lower bowel examinations). Ninety-six per cent of the units undertook audit. Urgent waiting times were 1.2 weeks and routine 3.4 weeks (range = 1.0 to 6.0). The annual throughput of 22 units in the past year was 8,478 procedures (4506 OGD, 3,972 lower bowel examinations). Out of 24,195 OGDs there were three reported complications (one perforation of pharyngeal pouch, treated conservatively, one chest pain after over-insufflation, and one slow recovery after intravenous sedation); there was no mortality. Out of 12,260 lower bowel procedures there was one perforated caecal carcinoma after flexible sigmoidoscopy (died), three perforations at colonoscopy and seven other minor complications.

CONCLUSIONS

Endoscopy in primary care appears to be a safe procedure. This good safety record is probably attributable to careful case selection and minimal use of intravenous sedation.