Meaden C, Joshi M, Hollis S, Higham A, Lynch D
Royal Lancaster Infirmary, Lancaster, UK.
Endoscopy. 2006 Jun;38(6):553-60. doi: 10.1055/s-2006-925164.
Rising demand for general diagnostic upper gastrointestinal endoscopy in the UK 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, but it is not known whether nurses can perform general diagnostic upper gastrointestinal endoscopy as competently as doctors.
A randomized controlled non-inferiority trial compared the adequacy and the accuracy of diagnostic upper gastrointestinal endoscopies performed by five medical and two nurse endoscopists. The videotaped procedures were assessed by a consultant gastroenterologist blinded to the identity of the endoscopist.
641 patients were randomly allocated (before attendance and consent procedure) to endoscopy carried out either by a doctor or a nurse. Of these, 412 were enrolled and 367 (89 %) were included in the analysis. An adequate view was obtained throughout in 53.4 % (93/177) of doctor endoscopies and 91.6 % (174/190) of nurse endoscopies (difference 38.2 %, 95 % CL 30.5 %, 47.2 %). In adequately viewed areas, the mean agreement between doctor and expert was 81.0 % and between nurse and expert it was 78.3 % (difference between the means 2.7 %, 95 % CL - 1.0 %, 6.4 %). There was no difference between doctors and nurses in the rate of biopsy performance (90.4 % and 91.1 %, respectively, P = 0.862). Nurses took longer (8.1 minutes vs. 4.6 minutes, P < 0.001) and used intravenous sedation more often (57.6 %, P = 0.027). Adequacy of view correlated positively with endoscopy duration ( P < 0.001), but diagnostic accuracy correlated inversely with duration ( P < 0.001). Neither adequacy or accuracy correlated significantly with use of intravenous sedation.
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.
在英国，普通诊断性上消化道内镜检查的需求不断增加，医生在合理时间内提供这项服务的能力已无法满足需求。一种解决办法是培训护士来实施该操作，但尚不清楚护士进行普通诊断性上消化道内镜检查的能力是否能与医生相当。
一项随机对照非劣效性试验比较了5名医生内镜医师和2名护士内镜医师进行诊断性上消化道内镜检查的充分性和准确性。录像操作由一位对内镜医师身份不知情的胃肠病学顾问进行评估。
641例患者（在就诊和同意程序之前）被随机分配接受由医生或护士进行的内镜检查。其中，412例患者登记入组，367例（89%）纳入分析。医生内镜检查中全程获得充分视野的比例为53.4%（93/177），护士内镜检查中这一比例为91.6%（174/佃0）（差异38.2%，95%可信区间30.5%，47.2%）。在视野充分的区域，医生与专家之间的平均一致性为81.0%，护士与专家之间为78.3%（均值差异2.7%，95%可信区间-1.0%，6.4%）。医生和护士在活检操作率上没有差异（分别为90.4%和91.1%，P = 0.862）。护士花费的时间更长（8.1分钟对4.6分钟，P < 0.001），且更频繁地使用静脉镇静（57.6%，P = 0.027）。视野充分性与内镜检查持续时间呈正相关（P < 0.001），但诊断准确性与持续时间呈负相关（P < 0.001）。视野充分性或准确性与静脉镇静的使用均无显著相关性。
在护士进行的内镜检查中，充分检查的比例远高于医生。在视野充分的区域，护士和医生在准确性上没有显著差异。护士能够像医生一样胜任准确的普通诊断性上消化道内镜检查服务。
