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.
