Flexible Sigmoidoscopy Performed by Nurses

Introduction

The aim of flexible sigmoidoscopy is to visualise the distal colon and rectum in order to detect pathological conditions that are causing symptoms, or to diagnose asymptomatic diseases such as colorectal polyps and carcinoma. In addition, pathological conditions identified at sigmoidoscopy can often be treated during the same endoscopic session.

Colorectal cancer is relatively common, being the second most common tumour of the developed world, and early diagnosis is associated with better outcomes. There is considerable evidence that removal of polyps from the colon and rectum decreases the risk of subsequent development of colorectal cancer. Because of this, all polyps encountered on endoscopic examination should either be removed by polypectomy or biopsied, and a histopathological diagnosis obtained in either case. Public awareness of this disease is increasing and more people are presenting with lower gastrointestinal symptoms. A significant reduction in the risk of developing colorectal cancer has been reported by teams involved in flexible sigmoidoscopy screening programmes [1], and this has led to a rapidly increasing use of flexible sigmoidoscopy as a population-based screening tool. Population studies suggest that flexible sigmoidoscopic screening should be available to asymptomatic adults at the age of 50 years. For these reasons, there has been a rapid increase in demand for endoscopy services, which places great demands on medical institutions, in terms of both time and cost.

When flexible sigmoidoscopy was first developed, senior clinicians carried out all the procedures, but the increasing demands on the service have led to the development of non-physician endoscopist services. The lead in this came initially from the USA, where non-medically-trained staff have been carrying out endoscopic examinations since the early 1970s [2]. Initially, there were few non-medical endoscopists, but there has been a rapid increase in their number in the last 10 years. In many institutions, members of the nursing profession have taken on this role, and have been backed by professional guidelines from both nursing bodies (Society of Gastroenterology Nurses and Associates Practice Committee) and medical societies (British Society of Gastroenterology Endoscopy Section Working Party). An advantage of training nurses to perform the procedure is that nurses are already providing healthcare in the field and are in a good position to learn the skills needed as part of an extended role. It has been firmly established that nurse-performed flexible sigmoidoscopy is as accurate for detecting lesions as medical practitioner-performed flexible sigmoidoscopy [3].

The role of flexible sigmoidoscopy performed by nurses is to detect distal colorectal lesions in symptomatic patients, and to perform screening of the distal colon and rectum in asymptomatic, at-risk individuals. The benefits of the procedure being performed by trained nurses are the financial savings and the increased number of procedures that can be performed per unit of time.

References

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