Gastrointestinal Endoscopy Nurse Experience and Polyp Detection During Screening Colonoscopy

Abstract

Background & Aims-The effect of GI endoscopy nursing experience on polyp detection is unknown. The aim of this study was to determine whether nurse experience is associated with odds of polyp detection.

Participation by experienced endoscopy nurses increases the detection rate of colon polyps during a screening colonoscopy: a multicenter, prospective, randomized study

“…In accordance with previous studies, the findings of the current study suggest that a high rate of nurse turnover may have a potential negative impact on colonoscopy outcomes. 22,26 Therefore, we believe in seeking practical means to support and retain experienced endoscopy nurses. We categorized the level of endoscopy nurse experience according to work-years in the GI endoscopy unit.…”

“…26 The same investigators, in a retrospective analysis of 3631 colonoscopies, also reported that procedures staffed by more experienced endoscopy nurses (Ն6 months) have increased odds of detecting colon polyps (OR 1.26; 95% CI, 1.09-1.46), but the role of endoscopy nurses in their study was limited to sedation, monitoring the patient, and assistance with the procedure. 22 Several pilot studies have examined the learning curve for nurse endoscopists performing flexible sigmoidoscopy and colonoscopy. [27][28][29] However, the effect of GI endoscopy nurse participation on lesion detection, which is the primary goal of colonoscopy, has not been previously reported in a prospective setting.…”

“…The answer was partly provided by another study by Peters et al, 21 showing that the positive impact of a second observer on detection rates was associated with the second observer's experience (level of fellowship training in their study). Interestingly, Dellon et al 22 reported that the experience of the GI endoscopy nurse influenced PDRs. In that study, colonoscopies staffed by more experienced GI endoscopy nurses had increased odds of polyp detection (odds ratio [OR] 1.26; 95% CI, 1.09-1.46).…”

Response

“…2 The preamble of the guideline claimed that the medical literature was searched using PubMed; yet, a search using the keywords nurse and colonoscopy yielded a number of studies reporting the outcomes of nurses performing colonoscopy. [2][3][4][5][6] For readers to critically appraise, reproduce, and perhaps update the guidelines, it would be useful if such guidelines included the search details (database, keywords used, and period of search). We are concerned that, in an era of increased need for colorectal cancer screening and subsequent surveillance, the role and potential of nurse colonoscopists might have been minimized by an incorrect level-3 recommendation, instead of being capitalized upon as a precious resource.…”

Endoscopy Nurse Participation May Increase the Polyp Detection Rate by Second-Year Fellows during Screening Colonoscopies

“…It has been our clinical experience that all aspects of the procedure may be facilitated by experienced endoscopy nurses, especially colonoscopy performed during gastroenterology fellowship training. Furthermore, trainees or a second, non-physician (nurse or technician) participation as an additional observer may be associated with polyp and adenoma detection 13-15. A previous retrospective study reported that procedures staffed by nurses with ≤6 months of endoscopy nursing experience had 1.26-fold likelihood of not detecting a polyp compared with nurses with more experience 13.…”