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Endoscopy 2014; 46(05): 401-410
DOI: 10.1055/s-0034-1365310
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Non-physician performance of lower and upper endoscopy: a systematic review and meta-analysis

Lukejohn W. Day
1   Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
2   GI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, California, USA
,
Derrick Siao
3   Gastroenterology Division, Department of Medicine, University of California, San Francisco, California, USA
,
John M. Inadomi
4   Department of Medicine, Division of Gastroenterology and Hepatology, University of Washington, Seattle, USA
,
Ma Somsouk
1   Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
2   GI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, California, USA
› Author Affiliations
Further Information

Publication History

submitted 15 October 2013

accepted after revision 16 January 2014

Publication Date:
13 March 2014 (online)

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Commentaire de travail de Day LW et al., pp. 401Endoscopy 2014; 46(05): 455-455
DOI: 10.1055/s-0034-1367550

Background and study aims: Demand for endoscopic procedures worldwide has increased while the number of physicians trained to perform endoscopy has remained relatively constant. The objective of this study was to characterize non-physician performance of lower and upper endoscopic procedures.

Patients and methods: Bibliographical searches were conducted in Medline, EMBASE, and Cochrane Library databases. Studies were included where patients underwent flexible sigmoidoscopy, colonoscopy, or upper endoscopy done by a non-physician (nurse, nurse practitioner, physician assistant) and outcome measures were reported (detection of polyps, adenomas, cancer, and/or adverse events). Pooled rates were calculated for specific outcomes and rate ratios were determined for selected comparison groups.

Results: Most studies involved nurses performing flexible sigmoidoscopies for colorectal cancer screening. Nurses and nurse-practitioners/physician assistants performing flexible sigmoidoscopies showed pooled polyp detection rates of 9.9 % and 23.7 %, adenoma detection rates of 2.9 % and 7.2 %, colorectal cancer detection rates of 1.3 % and 1.2 %, and adverse event rates of 0.3 and 0 per 1000 sigmoidoscopies, respectively. There was no significant difference between polyp and adenoma detection rates in sigmoidoscopy performance studies comparing nurses or nurse-practitioners/physician assistants with physicians. For the 3 studies of non-physician performance of colonoscopy, pooled adenoma detection rate was 26.4 %, cecal intubation rate was 93.5 %, and adverse event rate was 2.2 /1000 colonoscopies. In the few studies examining upper endoscopies, 99.4 % of upper endoscopy procedures performed by nurses were successful with no reported adverse events.

Conclusion: Available studies suggest that when non-physicians perform endoscopic procedures, especially lower endoscopies, outcomes and adverse events are in line with those of physicians.

 

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