Category Archives: Colonoscopy

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy: Regional variations in endoscopy rates

To examine regional variations in gastroscopy and colonoscopy rates, three-year average rates for 1994 to 1996 and 1999 to 2001 were calculated for each health region and the province as a whole. Figure 5 shows the 95% CIs for the gastroscopy and colonoscopy rate for 1999 to 2001 for each health region. In each three-year time period, there were marked variations in regional rates that exceeded what would be expected by chance alone (P<0.0001 for each period). There was a 3.3-fold difference between the highest and lowest regional gastroscopy rates in 1994 to 1996 and a 2.9-fold difference in 1999 to 2001. Continue reading

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy: Provincial endoscopy rates (Part 2)

ColonoscopyFrom 1994 to 2001, there was no significant difference between men and women in the age-adjusted gastroscopy rates. For example, in 2001, the age-adjusted gastroscopy rate was 11.6 (95% CI 11.3 to 11.8) for men and 11.5 (95% CI 11.3 to 11.8) for women. There was no appreciable change in the age-specific flexible sigmoidoscopy rates between 1995 and 2001. Continue reading

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy: Provincial endoscopy rates (Part 1)

Age-specific rates for men and women for each of the three endoscopic procedures are shown in Figure 3. The increase in colonoscopy rates was seen in all adult age groups. The age-adjusted colonoscopy rate per 1000 men increased from 4.8 (95% CI 4.6 to 5.0) in 1994 to 9.8 (95% CI 9.6 to 10.1) in 2001. Continue reading

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy: Sample

gastroscopiesRecords on 120,224 individuals who underwent 161,591 colonoscopies, 162,000 individuals who underwent 242,163 gastroscopies and 84,689 individuals who underwent 104,914 flexible sigmoidoscopies from January 1, 1994 to March 31, 2002 were provided by Alberta Health and Wellness. Postal code of residence was missing for 388 (0.24%), 746 (0.31%) and 398 (0.38%) of those undergoing a colonoscopy, gastroscopy or flexible sigmoidoscopy, respectively. Continue reading

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy: Analysis (Part 2)

Rates were calculated for the entire province and for each health region (2001 boundaries). To insure stable rates for the health region analysis, three-year average rates were calculated and three northern health regions (regions 14, 15 and 17) were grouped together. Each patient was assigned a health region of residence using a postal code to health region link created by Alberta Treasury. Bonferonni corrected 95% CIs were calculated for each rate. To test the null hypothesis of equality of rates, the test described by Carriere and Roos was used. Continue reading

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy: Analysis (Part 1)

procedures performedFor each population, a single summary rate is calculated that reflects the numbers of events that would have been expected if the populations being compared had identical distributions by age and sex. Therefore, the age-sex adjusted rate is not the same as the observed ‘crude’ rate. However, because the age and sex distribution of the Alberta population during the years included in this study is so similar to the 1991 Canadian population, the crude Alberta endoscopy rates per 1000 population are always very close to the age-sex adjusted rates. Rates for 2002 were estimated based on procedures performed until March 31, 2002. Continue reading

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy: Data sources and Sample selection

Data sources

Data from the Alberta Health Care Insurance Plan (AHCIP) on physician payments for endoscopy-related services were obtained from Alberta Health and Wellness, the provincial government department responsible for administering health care. Data elements included patients’ date of birth, sex, postal code of residence at date of service, service date, procedure code, up to three diagnostic codes, facility code and service provider specialty. Annual population estimates for Alberta and each of Alberta’s 17 health regions for 1994 to 2002 were obtained from Alberta Health and Wellness. Continue reading

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy (Part 3)

publicly funded universal insurance programSpecific objectives were to determine provincial procedure rates from 1994 to 2002; to determine if significant regional variations in procedure rates exist; to determine polyp prevalence rates and whether individual endoscopists polypectomy rates depend on their annual colonoscopy volume; and to determine patterns of colonoscopy use following a flexible sigmoidoscopy or a polypectomy.

To meet these objectives, the author examined endoscopy use in Alberta, Canada. In 2001, this Canadian province had a population of 3.06 million with two large urban centres (population greater than 750,000), several smaller cities and large, less populated rural and northern areas. Continue reading

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy (Part 2)

Because endoscopy expertise is concentrated in specialists who are located primarily in larger urban areas, limited access to endoscopy by those residing in rural areas is a valid concern. Significant regional variation in gastroscopy rates was reported among Medicare beneficiaries in the United States in 1981. However, the degree of variation was the sixth lowest among the 30 procedures examined. Variation in endoscopy rates was also noted in Quebec in 1994. These two sets of data are now outdated. Continue reading

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy (Part 1)

health care resourcesWhen health care resources are limited, the understanding of how medical procedures are used in a population is important to identify potential inequities or inefficiencies and to plan for future needs. Since the advent of flexible endoscopes in the late 1960s, endoscopy of the upper and lower gastrointestinal (GI) tract has assumed a critical role in the diagnosis and treatment of disorders of the esophagus, stomach, duodenum, terminal ileum and colon. The most commonly performed endoscopic procedures of the GI tract are flexible sigmoidoscopy, colonoscopy and esophagogastro-duodenoscopy. Continue reading