Nurses Performing Upper GI Endoscopy

Journal Watch. 2003;2(9) 

Worldwide, a limiting factor in the use of endoscopy is the lack of trained gastroenterologists. Research has shown that nonphysician clinicians (such as nurses) with specific training can successfully perform diagnostic sigmoidoscopy, thereby increasing the availability of this diagnostic tool; however, this approach has not been evaluated for other endoscopic procedures.

Investigators in London retrospectively reviewed records of 3009 patients who had undergone endoscopy in their institution. About half of these procedures were performed by 2 nurses and the other half were performed by 15 gastroenterologists. Patients with liver disease, with bleeding, or in whom therapeutic interventions were likely were excluded. In multivariate analysis, no correlation was seen between endoscopist type and findings of significant disease.

The researchers then prospectively evaluated patient apprehension, sedation, discomfort, and satisfaction among 480 patients who were undergoing elective endoscopy. Again, they found no difference for any of these variables between patients who underwent the procedure with a nurse or with a gastroenterologist. The authors conclude that trained nurse practitioners can perform routine diagnostic upper endoscopy as safely and achieve similar patient satisfaction ratings as gastroenterologists.

These results suggest that highly trained nurses can perform endoscopy in settings where a gastroenterologist is available for consultation and therapy and the patient is unlikely to require endoscopic therapy. It is important to note that the nurses in this study had undergone specific training for endoscopy (at least 150 physician-supervised procedures) and that the patient population was highly selected to exclude patients who would require endoscopic intervention other than biopsy. The patients in the prospective portion of the study were not randomized, which raises the possibility of selection bias. Although the number of significant findings was similar for nurses and gastroenterologists, we do not know about the accuracy of these diagnoses. Despite these limitations, it appears that nurses with rigorous training have the technical skill to perform diagnostic upper endoscopy in a highly selected population. The applicability of this approach might be limited by restrictions on the administration of sedatives by nurses. As with sigmoidoscopy, a gastroenterologist should be available for consultation and technical assistance.

-- David J. Bjorkman, MD, MSPH, SM (Epid.)

Smale S et al. Upper gastrointestinal endoscopy performed by nurses: Scope for the future? Gut 2003 Aug; 52:1090-4.

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