Nurse endoscopy in a district general hospital

Goodfellow, Peter; Fretwell, Ian A; Simms, J M

doi:10.1308/003588403321661343

Cited by 16 publications

(17 citation statements)

References 10 publications

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“…There were a total of 19 studies with non-physicians performing flexible sigmoidoscopy; 7 studies[5, 13, 17–19, 25, 26] involving mid-levels performing 3,976 flexible sigmoidoscopies and 12 studies[4, 11, 12, 14–16, 20–22, 24, 27, 28] with nurses performing 14, 886 flexible sigmoidoscopies. Among mid-levels performing flexible sigmoidoscopies (N=7), the polyp detection rate was 23.7% (95% CI 22.4–25.1%).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2014

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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 lower and upper endoscopic procedures performed by non-physicians. Patients and methods Bibliographical searches were conducted in Medline, EMBASE, and Cochrane library databases. Studies were included if patients underwent flexible sigmoidoscopy, colonoscopy or upper endoscopy by a non-physician (nurse, nurse practitioner, physician assistant) and had outcome measures reported (polyps, adenomas and/or cancer detected, adverse events). Pooled rates were calculated for specific outcomes and rate ratios were determined for selected comparison groups. Results The majority of studies included nurses who performed flexible sigmoidoscopies for colorectal cancer screening. Nurses and nurse practitioners/physician assistants who performed flexible sigmoidoscopies had a pooled polyp detection rate of 9.9% and 23.7%, adenoma detection rate of 2.9% and 7.2%, colorectal cancer detection rate of 1.3% and 1.2% and an adverse event rate of 0.3 and 0 per 1,000 sigmoidoscopies, respectively. There was no significant difference between polyp and adenoma detection rates in studies comparing nurses or nurse practitioners/physician assistants with physicians performing sigmoidoscopy. Among studies of non-physicians performing colonoscopies (n=3), the pooled adenoma detection rate was 26.4%, cecal intubation rate of 93.5% and an adverse event rate of 2.2/1,000 colonoscopies. Of 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 in the literature suggest that non-physicians perform endoscopic procedures, especially lower endoscopies, with outcomes and adverse events in line with physicians.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2014

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“…Furthermore, as with any new technique, its proper implementation involves experience and a learning curve to minimize errors in interpretation. Previous studies of conventional endoscopy demonstrated variability in findings and interpretations among gastroenterologists (5)(6)(7)(8)(9), as well as between gastroenterologists and nurses (10)(11)(12)(13). Most of the differences were associated with level of experience and borderline results (8,9).…”

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confidence: 97%

“…This strategy saved time and money without compromising the quality of the examination. It is supported by a wealth of evidence in the literature that gastroenterology nurses can efficiently interpret other types of endoscopic data (10)(11)(12).…”

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confidence: 98%

Capsule Endoscopy Examination—Preliminary Review by a Nurse

Niv

2005

Dig Dis Sci

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Capsule endoscopy (CE) has been recommended as the method of choice for diagnostic endoscopy of the small bowel. An experienced nurse, after proper training, may contribute to the endoscopy procedures as previously described for sigmoidoscopy. The aim of this study was to evaluate the ability of an experienced gastroenterology nurse to prepare CE records for physician interpretation, by detecting abnormal thumbnails. A prospective, observational design was used. Fifty CE videos were preread by a specially trained gastroenterology nurse who thumbnailed the abnormalities detected for interpretation by the gastroenterologist. The nurse's description of the lesions and the calculated gastric and bowel transit times were compared to the interpretation of the videos made directly by the gastroenterologist (gold standard). The primary end point of the study was the quality of the nurse's pathology findings; the secondary end point was the cost effectiveness of this practice. There was complete agreement between the nurse and gastroenterologist for all 12 cases interpreted as normal by the gastroenterologist. In the remaining 38 cases, the nurse created 130 thumbnail selections and the physician, 99. Complete interobserver agreement was achieved for 93 of the 96 lesions categorized as "significant" by the physician (96.9%). After all relevant variables were taken into account, this approach saved $324 per CE examination. The use of nurse practitioner to preread CE videos and prepare thumbnail selections for further assessment by the gastroenterologist appears to be safe, reliable, and cost effective.KEY WORDS: M2A; capsule endoscopy; endoscopy; enteroscopy; small bowel.Recent studies recommending video capsule endoscopy (CE) as the method of choice for small bowel diagnostic endoscopy have led to its growing application in medical practice (1-4). At present, however, the extensive use of CE is limited by its high cost. Furthermore, as with any new technique, its proper implementation involves experience and a learning curve to minimize errors in interpretation. Previous studies of conventional endoscopy demonstrated variability in findings and interpretations among gastroenterologists (5-9), as well as between gastroenterologists and nurses (10-13). Most of the differences were associated with level of experience and borderline results (8, 9). There was a high level of agreement for clear and well-known findings, such as polyps and ulcers, and a low level for indeterminate lesions such as irregular "Z-lines." Levinthal et al. (12) in a small study of 20 capsule videos, found that goal results were achieved when the capsule results were first read by a trained gastroenterology nurse who demarcated the areas of suspected pathology for further assessment by the physician. This strategy saved time and money without compromising the quality of the examination. It is supported by a wealth of evidence in the literature that gastroenterology nurses can efficiently interpret other types of endoscopic data (10-12).The aim of the...

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“…3,4 Urology nurse practitioners have been shown to be effective in running cystoscopy lists 5,6 and nurse-led endoscopy is now utilised within many hospital trusts with guidelines produced by a working party set up by the British Society of Gastroenterologists for nurse endoscopists. 7,8 Surgical care practitioners are also used for saphenous vein harvesting in cardiothoracic surgery. 9,10 Over 1000 patients per year are referred for minor surgical procedures by general practitioners to St Mary's NHS Trust.…”

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confidence: 99%