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 19 November 2017

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News

Trained nurses perform colonoscopies safely and effectively

Two separate research teams have investigated the role of the nurse colonoscopist, and reported their findings to the British Society of Gastroenterology Annual Meeting, held this week in Birmingham, England.

News image

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In the first study, researchers from St. Mark's Hospital, London, England, initiated a nurse colonoscopy-training program, based on JAG 2001 guidelines.

The first 160 colonoscopies (67 male, 93 female, mean age 56 years) performed by a nurse endoscopist were reviewed. Of these, the initial 100 cases were performed under the direct supervision of an expert.

After this time, an assessment of performance was evaluated, and the following 60 cases were performed without supervision.

The nurse endoscopist performed routine polypectomy on polyps less than 10 mm.

Indications for colonoscopy included rectal bleeding (30%), assessment of IBD (15%), altered bowel habit (15%), pain (11%), diarrhea (9%), anemia (8%), cancer follow-up (5%), polyp follow-up (4%), and family history of cancer (2%).

The overall cecal intubation rate was 94% (146/160) - assistance was given in 8% of cases due to looping /fixed sigmoid.

The authors found that median sedation administered was pethidine 25 mg, midazolam 1.25 mg, and buscopan 20 mg.

Overall findings were normal in 70 cases (48%), IBD in 25 (17%), adenomas in 18 (12%), diverticulosis in 13 (9%), cancer in 9 (6%), metaplastic polyps in 7 (5%), and other outcomes in 4 (3%).

The nurse endoscopist performed polypectomy in 21 (14%) cases with no complications.

Dr M. E. Vance concluded on behalf of the group, "A nurse endoscopist with an experienced background in flexible sigmoidoscopy can, with specialized training, safely progress to perform colonoscopy for diagnostic referrals."

Nurse colonoscopists could help meet the increasing demand for diagnostic colonoscopy.
BSG
In the second study, a team from the Northern General Hospital, Sheffield, England, prospectively compared doctor and nurse performed colonoscopies.

A total of 167 patients attending routine diagnostic colonoscopy were included in the study.

Examinations were performed using standard video-endoscopies and were recorded for independent review.

Endoscopists were instructed to use midazolam, pethidine, and buscopan according to their usual practice.

Endoscopists and nurse assistants graded the patient's pain and tolerance on visual analogue scales (VAS) and a validated questionnaire and VAS were given to the patient following the procedure.

Of the patients, 84 (38 female) were examined by the doctor and 83 (48 female) by the nurse.

Intention to treat cecal and ileal intubation rates were 98% and 83%, respectively, for those carried out by the doctor, and 94% and 72% for those conducted by the nurse.

Failure to reach the cecum was due to obstructing cancer (1) and diverticular disease (1) in the doctor group, and patient discomfort (3), poor preparation (1), and obstructing Crohn's stricture in the nurse group.

Pain and tolerance scores were similar, but the nurse used more midazolam and pethidine.

No significant complications occurred in either group.

Author S. Pathmakanthan and colleagues commented that appropriately trained nurses perform safe and effective colonoscopy examinations, with cecal and ileal intubation rates exceeding JAG recommendations.

Expansion of the nurse colonoscopist role may help to meet the increasing demand for diagnostic colonoscopy, they concluded.

BSG
20 March 2002

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