Experience Of Nurse Practitioners Performing Colonoscopy After Endoscopic Training In Over 1,000 Patients

The majority of literature that involves non-physician endoscopists pertains to performance of flexible sigmoidoscopy, with only limited reports of performance in colonoscopy. ASGE guidelines have stated that there is insufficient data to support non-physician endoscopists to perform colonoscopy. To assess the quality of colonoscopy performed by GI fellowship-trained nurse practitioners (NPs). This was a retrospective study performed at a single tertiary endoscopy center. Colonoscopies performed by three GI-specialized NPs after having completed training of at least 140 supervised colonoscopies were reviewed for analysis. Inclusion criteria were patients undergoing colonoscopy for colorectal cancer screening purposes. Outcomes included colonoscopy quality indicators as defined by the ASGE/ACG Taskforce. The study included 1,102 subjects (mean age 56.2 years, Female 51.5%, African American 73.9%) who underwent screening colonoscopies by three NPs. Cecal intubation was successful in 1,007 (99.5%) subjects. The mean adenoma detection rate was 35.6%. There were no adverse events including colonic perforations or delayed post-polypectomy bleeding events. We describe the performance of colonoscopy by three fellowship-trained NPs in colonoscopy in the United States. The NPs satisfied the quality indicators proposed by the ASGE/ACG Taskforce, showing adequately trained NPs can safely and effectively perform colonoscopy. With the demand for colonoscopy exceeding the supply, non-physicians could be part of the solution to this problem. However, non-physicians, similar to physicians, should be subjected to a quality monitoring program.