Système gastro-intestinal et digestif

Abstrait

Experience of a Nurse Practitioner Performing Colonoscopy at a Tertiary Center in the United States

Monica L Riegert, Mouen A Khasab, Anthony N Kalloo

Background: The majority of the literature that involves non-physician endoscopists pertains to the performance of flexible sigmoidoscopy, with only limited reports of their performance of colonoscopy. Recent ASGE guidelines stated that there is insufficient data to support non-physician endoscopists to perform colonoscopy.

Objective: To assess the performance of a fellowship-trained nurse practitioner (NP) in colonoscopy.

Methods: The NP's performance was evaluated using quality indicators for colonoscopy as defined by the ASGE/ACG Taskforce, including appropriate indication, informed consent, appropriate surveillance interval, documentation of bowel preparation quality, photo documentation of cecal landmarks, cecal intubation rate, adenoma detection rate (ADR), withdrawal time, and incidence of procedure-related complications.

Results: The study included 300 consecutive subjects (mean age 55.4 years, female 48.3%, African American 84.6%) who underwent average risk screening colonoscopies. A total of 385 polyps were detected for a mean polyp detection rate of 1.28 per colonoscopy. The overall adenoma detection rate was 35.0%, with 41.3% detection in men and 28.3% detection in females. Cecal intubation was successful in 297 (99.0%) subjects. The mean withdrawal time was 19.3 minutes (range 6.7-66.7 minutes). There were no adverse events including colonic perforations or post-polypectomy bleeding.

Conclusion: We describe the technical and cognitive performance of a non-physician in colonoscopy in the United States. The NP adequately satisfied all of the quality indicators proposed by the ASG/ACG Taskforce. With the demand for screening colonoscopies exceeding the supply of qualified providers, non-physicians could be a potential solution to increasing the capacity of endoscopists needed to perform CRC screening. However, non-physicians, similar to physicians, should be subjected to a quality monitoring program.