Upper gastrointestinal endoscopy performed by nurses: scope for the future?

Abstract

Background: Previous researchers have shown that non-medical endoscopists can perform lower gastrointestinal endoscopy as safely and effectively as medical staff. However, it is not known if upper gastrointestinal endoscopy performed by medical and non-medical endoscopists in clinical practice yields similar results in terms of performance, patient discomfort, and satisfaction. Aim: To determine differences in the yield of diagnosis for significant disease during upper gastrointestinal endoscopy performed by nurse and medical endoscopists and to measure patient discomfort, satisfaction, and attitudes towards future endoscopy.Patients: This two part study included 3009 patients in a retrospective analysis and 480 in a prospective study. Methods: The first part of the study assessed indications for endoscopy, diagnoses, and procedures performed by medical and nurse endoscopists. In a second prospective study, 480 patients were included to determine the association between endoscopist type and sedation, patient anxiety, discomfort, satisfaction, and attitudes towards future sedation. Results: No patient refused endoscopy by either a nurse or medical endoscopist and there were no complications in either group. Nurses performed 1487 procedures and reported fewer endoscopies as "normal" than medical staff (p=0.006). Multivariate analysis showed that male sex, older age, inpatient status, dysphagia, and gastrointestinal bleeding, but not endoscopist type, were all associated with significant disease. In relation to discomfort and satisfaction, a similar proportion of patients received sedation in both groups (p=0.81). There were no differences in pre-procedure anxiety (p=0.61), discomfort during intubation (p=0.97), discomfort during examination (p=0.90), or post-procedure examination rating (p=0.79) in patients examined by medical or nurse endoscopists. Conclusion: Experienced nurses perform routine diagnostic gastroscopy safely in everyday clinical practice and with as little discomfort and as much patient satisfaction as medical staff.

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

“…There were three studies[28, 31, 32] that involved non-physicians performing 1,932 upper endoscopies with all of them performed by nurses. Nurses performing upper endoscopies had a successful esophageal and gastric pyloric intubation rate of 99.4% (95% CI 99.0–99.7%).…”

“…Available data with regards to patient satisfaction is sparse in this area; however limited reports illustrate that patients would be willing to undergo a repeat procedure by a non-physician and that no difference exists between non-physicians and physicians in terms of patient preference for who performs their procedure. In our included studies, there was high patient satisfaction with respect to non-physicians performing flexible sigmoidoscopy[17, 27], colonoscopy[29, 30] and upper endoscopy[32] and in many cases there was greater patient satisfaction and lower pain scores with non-physicians performing endoscopy. At the same time, a number of academic centers and healthcare organizations have adopted the use of nonphysicians to perform simple endoscopic procedures[17, 30, 37–39] with successful outcomes and patient experiences.…”

Anaesthesia and sedation for gastrointestinal endoscopy

“…Similar recommendations were made by the ASA [7]. The acceptance of nurseadministered sedation raises another question in the units in which nurse endoscopists practise: should nurse-administered sedation be provided for nurse endoscopists, and if so, what support should be available [38]? To date, studies of safety have involved relatively small numbers, and much larger trials would be needed to demonstrate unequivocally the safety of non-anaesthesiologist sedation.…”

Non-Physician Endoscopy: How Far Can We Go?

“…In reviews and studies of endoscopies in the upper and lower gastrointestinal tract [10,11,12,13,14,15], examination quality and diagnostic precision were also not significantly different. Equally, in gastroscopy studies by Wildi et al [16] and Smale et al [17] no significant differences were recognized in terms of the actual result or anxiety of the patients (p = 0.67), entering of the endoscope (p = 0.97) or diagnostic quality (p = 0.90). A negative feature of the study by Wilde et al is the use of a pediatric (nurse endoscopist) and standard (gastroenterologist) gastro scope.…”