Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1423-E1428
DOI: 10.1055/a-1221-4546
Original article

Experience of nurse practitioners performing colonoscopy after endoscopic training in more than 1,000 patients

Monica Riegert
1   The Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
,
Monica Nandwani
2   Stanford Health Care, Center for Advanced Practice, Division of Gastroenterology and Hepatology, Stanford, California, United States
,
Bonny Thul
3   Winona Health, Winina, Minnesota, United States
,
Angela Chang Chiu
1   The Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
,
Simon C. Mathews
4   Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, United States
,
Mouen A. Khashab
1   The Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
,
Anthony Nicholas Kalloo
1   The Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Letter to:

Consensus statement from a group of colorectal surgeons for health equity and justiceEndosc Int Open 2022; 10(03): E227-E228
DOI: 10.1055/a-1672-3985

Abstract

Background and study aims The demand for screening colonoscopy has continued to rise over the past two decades. As a result, the current workforce of gastroenterologists is unable to meet the needs for colorectal cancer (CRC) screening. Therefore, solutions are needed to improve this disparity, with non-physician endoscopists being a potential option. However, current literature on the performance of non-physicians in endoscopy is limited. The aim of this study was to assess the quality of colonoscopy performed by three gastrointestinal fellowship-trained nurse practitioners (NPs).

Methods This was a retrospective study performed at a single tertiary academic medical center. Colonoscopies performed by three gastrointestinal-specialized NPs after having completed training of at least 140 supervised colonoscopies were reviewed for analysis. Inclusion criteria were patients undergoing colonoscopy for colorectal cancer screening purposes. Outcomes included colonoscopy quality indicators as defined by the American Society for Gastrointestinal Endoscopy/American College of Gastroenterology Taskforce (ASGE/ACG) Taskforce.

Results The study included 1,012 subjects (mean age 56.2 years, female 51.5 %, African American 73.9 %) who underwent screening colonoscopies by three NPs. Cecal intubation was successful in 997 subjects (98.5 %). Mean adenoma detection rate was 35.6 %. Mean withdrawal time was 18.9 minutes. There were no adverse events including colonic perforations or delayed post-polypectomy bleeding.

Conclusions Three fellowship-trained NPs in colonoscopy in the United States satisfied the quality indicators proposed by the ASGE/ACG Task force, demonstrating that adequately trained NPs can perform colonoscopy safely and effectively. With the demand for colonoscopy exceeding the supply, non-physicians could be part of the solution to meet the demands for CRC screening.



Publication History

Received: 28 February 2020

Accepted: 24 June 2020

Article published online:
22 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 American Cancer Society. Cancer Facts & Figures 2018. Atlanta, GA: American Cancer Society; 2018
    Google Scholar
  • 2 Kahi CJ, Pohl H, Myers LJ. et al. Colonoscopy and colorectal cancer mortality in the veterans affairs health care system: a case–control Study. Ann Intern Med 2018; 168: 481-488
    CrossrefPubMedGoogle Scholar
  • 3 Nishihara R, Wu K, Lochhead P. et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105
    CrossrefPubMedGoogle Scholar
  • 4 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopy polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
    CrossrefPubMedGoogle Scholar
  • 5 Joseph DA, Meester RG, Zauber AG. et al. Colorectal cancer screening: estimated future colonoscopy need and current volume capacity. Cancer 2016; 122: 2479-2486
    CrossrefPubMedGoogle Scholar
  • 6 Vijan S, Inadomi J, Hayward RA. et al. Projections of demand and capacity for colonoscopy related to increasing rates of colorectal cancer screening in the United States. Aliment Pharmacol Ther 2004; 20: 507-515
    CrossrefPubMedGoogle Scholar
  • 7 Dall T, Sen M, Zhang Y. et al. The impact of improved colorectal cancer screening rates on adequacy of future supply of gastroenterologists. The Lewin Group; 2009: 1-33 Available from: https://www.olympusamerica.com/corporate/docs/Lewin-Gastroenterologist-Report.pdf
    PubMedGoogle Scholar
  • 8 Brown ML, Klabunde CN, Mysliwiec P. Current capacity for endoscopic colorectal cancer screening in the United States: data from the National Cancer Institute survey of colorectal cancer screening practices. Am Journal Med 2003; 115: 129-133
    CrossrefPubMedGoogle Scholar
  • 9 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. Supply and Demand Projections for Internal Medicine Subspecialties: 2013-2025. Rockville, Maryland: 2016 Available from: https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/internal-medicine-subspecialty-report.pdf
    PubMedGoogle Scholar
  • 10 Department of Health and Human Services/Centers for Medicare & Medicaid Services. National Health Expenditures 2017 Highlights. 2019 Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf
    PubMedGoogle Scholar
  • 11 McClellan MB, Leavitt MO. Competencies and tools to shift payments from volume to value. JAMA 2016; 316: 1655-1656
    CrossrefPubMedGoogle Scholar
  • 12 Steinwachs D, Allen JD, Barlow WE. et al. NIH state-of-the-science conference statement: enhancing the use and quality of colorectal cancer screening. NIH Consens State Sci Statements 2010; 27: 1-31
    PubMedGoogle Scholar
  • 13 Schoenfeld P, Piorkowski M, Allaire J. et al. Flexible sigmoidoscopy by nurses: state of the art 1999. Gastroenterol Nurs 1999; 22: 254-261
    CrossrefPubMedGoogle Scholar
  • 14 Day LW, Siao D, Inadomi JM. et al. Non-physicians performing lower and upper endoscopy: a systematic review and meta-analysis. Endoscopy 2014; 46: 401-410
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Ikenberry SO, Anderson MA, Banerjee S. et al. Endoscopy by nonphysicians. Gastrointest Endosc 2009; 69: 767-770
    CrossrefPubMedGoogle Scholar
  • 16 Faigel DO, Baron TH, Lewis B. et al. Ensuring competence in endoscopy. ASGE Pres [Internet] 2006; 1-32 https://www.asge.org/docs/default-source/education/practice_guidelines/doc-competence.pdf?sfvrsn=6
    PubMedGoogle Scholar
  • 17 Rex DK, Petrini JL, Baron TH. et al. Quality indicators for colonoscopy. Am J Gastroenterol 2006; 101: 873-885
    CrossrefPubMedGoogle Scholar
  • 18 Rex D, Cohen J, Pike IM. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
    CrossrefPubMedGoogle Scholar
  • 19 Rex DK, Boland CR, Dominitz JA. et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on colorectal cancer. Am J Gastroenterol 2017; 112: 1016-1030
    CrossrefPubMedGoogle Scholar
  • 20 Harewood GC, Lieberman DA. Colonoscopy practice patterns since introduction of medicare coverage for average-risk screening. Clin Gastroenterol Hepatol 2004; 2: 72-77
    CrossrefPubMedGoogle Scholar
  • 21 Dall T, Chakrabarti R, Iacobucci W. et al. The complexities of physician supply and demand 2017 update: projections from 2015 to 2030. Washington, DC: Association of American Medical Colleges; 2017
    Google Scholar
  • 22 Cram P, Inadomi J, Cowen ME. et al. The impact of a healthy celebrity spokesperson on preventive health behavior: the Katie Couric effect. Arch Int Med 2003; 163: 1601-1605
    CrossrefPubMedGoogle Scholar
  • 23 Elta GH. GI training: where are we headed?. Am J Gastroenterol 2011; 106: 395-397
    CrossrefPubMedGoogle Scholar
  • 24 Carthon MB, Barnes H, Sarik DA. Federal policies influence access to primary care and nurse practitioner workforce. J Nurse Pract 2015; 11: 526-530
    CrossrefPubMedGoogle Scholar
  • 25 Newhouse RP, Stanik-Hutt J, White KM. et al. Advanced practice nurse outcomes 1990-2008: a systematic review. Nurs Econ 2011; 29: 230-250
    PubMedGoogle Scholar
  • 26 Miskovitz P. Colonoscopy, chapter 4. XX: InTech; 2011. ISBN: 978-953-307-568-6, PDF ISBN 978-953-51-6466-1, Published 2011-08-29
    CrossrefGoogle Scholar
  • 27 Vance M. The nurse colonoscopist- training and quality assurance. Gastroinest Endosc Clin N Am 2005; 15: 829-837
    CrossrefPubMedGoogle Scholar
  • 28 British Society of Gastroenterology. Non-medical endoscopists. BSG Guidelines in Gastroenterology. 2005: 1-6 Available from: https://www.bsg.org.uk/asset/BAD09C38-AB8A-4C00-ADBC336757130AB8/
    PubMedGoogle Scholar
  • 29 Pathmakanthan S, Murray I, Smith K. et al. Nurse endoscopists in United Kingdom health care: a survey of prevalence, skills and attitudes. J Adv Nurs 2001; 36: 705-710
    CrossrefPubMedGoogle Scholar
  • 30 Maslekar S, Hughes M, Gardiner A. et al. Patient satisfaction with lower gastrointestinal endoscopy: doctors, nurse and nonmedical endoscopists. Colorectal Dis 2010; 12: 1033-1038
    CrossrefPubMedGoogle Scholar
  • 31 Koornstra J, Corporaal S, Giezen-Beintema WM. et al. Colonoscopy training for nurse endoscopists: a feasibility study. Gastrointest Endosc 2009; 69: 688-695
    CrossrefPubMedGoogle Scholar
  • 32 van Putten PG, Ter Borg F, Adang RP. et al. Nurse endoscopists perform colonoscopies according to the international standard and with high patient satisfaction. Endoscopy 2012; 44: 1127-1132
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Harriot M, Sandha G, Semlacher E. et al. Nurse practitioner colonoscopy in colon cancer screening program: a novel and highly successful training and credentialing program in Canada [abstract]. DDW; 2012 Suppl A196
    PubMedGoogle Scholar
  • 34 Limoges-Gonzales M, Mann NS, Al-Juburi A. et al. Comparisons of screening colonoscopy performed by a nurse practitioner and gastroenterologists: a single-center randomized controlled trial. Gastroenterol Nurs 2011; 34: 210-216
    CrossrefPubMedGoogle Scholar
  • 35 Riegert M, Khashab M, Kalloo A. Experience of a nurse practitioner performing colonoscopy at a tertiary center in the United States. J Gastrointest Dig Syst 2015; 5: 3
    PubMedGoogle Scholar
  • 36 Cole A, Jackson JE, Doescher M. Urban-rural disparities in colorectal cancer screening: cross-sectional analysis of 1998-2005 data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance Study. Cancer Med 2012; 1: 350-356
    CrossrefPubMedGoogle Scholar