The rising demand for general diagnostic upper gastrointestinal endoscopy (GI) in the United Kingdom is outgrowing the capacity of doctors to provide this service within a reasonable time.
One solution is to train nurses to carry out the procedure.
However, it is not known whether nurses can perform general diagnostic upper gastrointestinal endoscopy as competently as doctors.
Dr Meaden and colleagues from England performed a randomized controlled non-inferiority trial.
The adequacy and the accuracy of diagnostic upper gastrointestinal endoscopies was compared by 5 medical and 2 nurse endoscopists.
The videotaped procedures were assessed by a consultant gastroenterologist blinded to the identity of the endoscopist.
The researchers randomly allocated 641 patients to endoscopy carried out either by a doctor or a nurse.
Of these, 412 were enrolled and 367 were included in the analysis.
The team obtained an adequate view throughout in 53% of doctor endoscopies and 92% of nurse endoscopies.
|53% of doctor vs 92% of nurse endoscopies obtained an adequate view|
In adequately viewed areas, the mean agreement between doctor and expert was 81% and between nurse and expert it was 78%.
The researchers observed no difference between doctors and nurses in the rate of biopsy performance.
Nurses took longer, and used intravenous sedation more often.
The team noted that adequacy of view correlated positively with endoscopy duration, but diagnostic accuracy correlated inversely with duration.
Neither adequacy or accuracy correlated significantly with use of intravenous sedation.
Dr Meaden's team concluded, “In endoscopies performed by nurses, the proportion of adequate examinations was much higher than that found for doctors.”
”In areas with an adequate view, there is no significant difference in accuracy between nurses and doctors.”
“Nurses can provide an accurate general diagnostic upper gastrointestinal endoscopy service as competently as doctors.”