Biomedical subjects
C J Godreau
Publications and source records attributed to C J Godreau.
Office-based colonoscopy in a family practice.
A total of 112 patients, 64 women and 48 men, underwent 157 in-office colonoscopies with intravenous sedation. A total of 113 polyps were found. Thirty polyps were of the diminutive (less than 0.6 cm) hyperplastic (metaplastic) or nonneoplastic type. Forty-three were of the diminutive adenomatous, or villous, neoplastic type, and 40 were neoplastic but larger than 0.6 cm. Biopsies and polypectomies were done. There were no instances of perforation, hemorrhage, or other major complications. A spectrum of other colorectal pathology was found, the majority of which was treated in the office. Patients were risk stratified for surveillance according to polyp histopathology, with nonneoplastic polyps assigned no risk, and neoplastic polyps assigned high risk status. This study demonstrates that for the most reliable prognostication and risk stratification, all polyps should be removed for histopathological assessment.
Adenocarcinoma of the stomach: a plea for early diagnosis.
In the United States, early diagnosis and cure of gastric carcinoma remain elusive. Patients with this disease commonly have gastrointestinal symptoms that often go unexplained. Physicians give gastric carcinoma a low priority in their differential diagnosis and are unaware of the risk factors patients may have. Patients may have a normal upper gastrointestinal series, and fiberoptic gastroscopy is delayed. Patients with unexplained indigestion and abdominal pain, coupled with such risk factors for gastric carcinoma as national origin, diet, heredity, and previous subtotal gastrectomy for gastric ulcers, should be given the opportunity of esophagogastroduodenoscopy.
Esophagogastroduodenoscopy by family physicians: a national multisite study of 717 procedures.
This is the first multisite report of esophagogastroduodenoscopies (EGDs) performed by family physicians. The first 717 EGDs performed by family physicians from 8 separate office practices provide a practical and safe rationale for selected cognitive and psychomotor aspects of continuing medical education after residency training. Although primarily in private practice, these physicians were affiliated with 6 academic institutions. This group of family physicians received training in short courses. The average amount of hands-on training before independent EGD was 8 supervised cases. Cumulatively, these data represent 227 months (18.9 years) of office practice. All cases were collected sequentially from the beginning of each physician's experience, and 454 cases were collected prospectively. Physicians reported excellent patient tolerance. Diagnostic yields were high, and biopsies were performed where appropriate. Pathologists reviewed biopsy specimens from 213 sites. The family physician endoscopic diagnosis agreed with the tissue diagnosis in 188 cases (88 percent). Physicians believed that EGD enhanced management or changed the diagnosis in more than 89 percent of cases. One bleeding complication requiring overnight hospitalization was noted. This complication rate 0.0014 (1/717) compares favorably with published subspecialty complication rates 0.0013 (1.3/1000). These data confirm the ability of some family physicians to perform EGD and suggest that continuation is safe. Biopsy analysis indicates diagnostic accuracy is high. Further study on the cognitive aspects and the defragmentation of care is needed.