Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
Gastrointest Endosc. 2011 Nov;74(5):1094-102. doi: 10.1016/j.gie.2011.06.033. Epub 2011 Sep 1.
No reported prospective, randomized study has evaluated the impact of an endoscopy nurse participating as a second observer during colonoscopy.
To determine whether the participation of an endoscopy nurse enhanced the polyp detection rate (PDR) and adenoma detection rate (ADR) during screening colonoscopy.
Multicenter, prospective, randomized study.
Academic hospitals.
A total of 844 consecutive patients undergoing screening colonoscopy.
Single observation by colonoscopist or dual observation by colonoscopist and endoscopy nurse during colonoscope withdrawal.
PDR and ADR.
No significant difference in patient demographic data, adequacy of bowel preparation, or mean withdrawal time was observed between the 2 groups. In total, 1153 polyps, including 762 adenomas, were detected in 791 patients. Seven nonpolypoid, depressed neoplastic lesions (0-IIc or combined types) were only detected in the dual observation group. A multivariate analysis revealed that experienced (≥ 2 years) endoscopy nurse participation significantly increased the PDR and ADR compared with those in the single observation group by a colonoscopist alone (adjusted odds ratio [OR] 1.58 [95% CI, 1.07-2.32]; adjusted OR 1.47 [95% CI, 1.01-2.12], respectively). Additionally, the PDR was significantly higher in the dual-observation group with fellows (<500 colonoscopies) and an experienced endoscopy nurse versus that in the single observation group (adjusted OR 2.07 [95% CI, 1.15-3.74]). There was no significant benefit of experienced nurse participation in the subgroup with experienced colonoscopists.
Absence of colonoscopist blinding.
Experienced endoscopy nurse participation increased the PDR and ADR during screening colonoscopy. However, the benefit of participation by experienced nurses appears to be exclusively with inexperienced colonoscopists.
目前尚无前瞻性、随机研究评估内镜护士作为第二观察者参与结肠镜检查对息肉检出率（PDR）和腺瘤检出率（ADR）的影响。
确定内镜护士参与是否提高筛查性结肠镜检查中的息肉检出率（PDR）和腺瘤检出率（ADR）。
多中心、前瞻性、随机研究。
学术医院。
844 例连续接受筛查性结肠镜检查的患者。
结肠镜医师单观察或结肠镜医师与内镜护士在结肠镜退镜时双观察。
PDR 和 ADR。
两组患者的人口统计学数据、肠道准备充分性或平均退镜时间无显著差异。791 例患者共检出 1153 个息肉，包括 762 个腺瘤。7 例非息肉样、凹陷型肿瘤性病变（0-IIc 或混合型）仅在双观察组中检出。多变量分析显示，与仅由结肠镜医师单观察相比，经验丰富（≥2 年）的内镜护士参与可使 PDR 和 ADR 显著增加（校正比值比[OR] 1.58[95%CI，1.07-2.32]；校正 OR 1.47[95%CI，1.01-2.12]）。此外，在经验丰富的内镜护士与低年资医师（＜500 例结肠镜检查）组成的双观察组中，PDR 显著高于单观察组（校正 OR 2.07[95%CI，1.15-3.74]）。在经验丰富的结肠镜医师亚组中，经验丰富的护士参与并未带来显著益处。
无结肠镜医师设盲。
经验丰富的内镜护士参与可提高筛查性结肠镜检查中的 PDR 和 ADR。然而，经验丰富的护士参与的益处似乎仅对经验不足的结肠镜医师有益。
