Demand for endoscopic procedures worldwide has increased while the number of physicians trained to perform endoscopy has remained relatively constant.
Dr Lukejohn Day and colleagues from Seattle, USA characterized non-physician performance of lower and upper endoscopic procedures.
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, and outcome measures were reported.
Pooled rates were calculated for specific outcomes and rate ratios were determined for selected comparison groups.
|Nurse-practitioners/physician assistants showed pooled polyp detection rates of 24%|
The team noted that 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 10% and 24%, adenoma detection rates of 3% and 7%, colorectal cancer detection rates of about 1% each, and adverse event rates of 0.3 and 0 per 1000 sigmoidoscopies, respectively.
The researchers observed 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%, cecal intubation rate was 94%, and adverse event rate was 2 per 1000 colonoscopies.
In the few studies examining upper endoscopies, the team noted that 99% of upper endoscopy procedures performed by nurses were successful with no reported adverse events.
Dr Day and colleagues conclude, "Available studies suggest that when non-physicians perform endoscopic procedures, especially lower endoscopies, outcomes and adverse events are in line with those of physicians."