Riegert Monica, Nandwani Monica, Thul Bonny, Chiu Angela Chang, Mathews Simon C, Khashab Mouen A, Kalloo Anthony Nicholas
The Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States.
Stanford Health Care, Center for Advanced Practice, Division of Gastroenterology and Hepatology, Stanford, California, United States.
Endosc Int Open. 2020 Oct;8(10):E1423-E1428. doi: 10.1055/a-1221-4546. Epub 2020 Sep 22.
The demand for screening colonoscopy has continued to rise over the past two decades. As a result, the current workforce of gastroenterologists is unable to meet the needs for colorectal cancer (CRC) screening. Therefore, solutions are needed to improve this disparity, with non-physician endoscopists being a potential option. However, current literature on the performance of non-physicians in endoscopy is limited. The aim of this study was to assess the quality of colonoscopy performed by three gastrointestinal fellowship-trained nurse practitioners (NPs). This was a retrospective study performed at a single tertiary academic medical center. Colonoscopies performed by three gastrointestinal-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 American Society for Gastrointestinal Endoscopy/American College of Gastroenterology Taskforce (ASGE/ACG) Taskforce. The study included 1,012 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 997 subjects (98.5 %). Mean adenoma detection rate was 35.6 %. Mean withdrawal time was 18.9 minutes. There were no adverse events including colonic perforations or delayed post-polypectomy bleeding. Three fellowship-trained NPs in colonoscopy in the United States satisfied the quality indicators proposed by the ASGE/ACG Task force, demonstrating that adequately trained NPs can perform colonoscopy safely and effectively. With the demand for colonoscopy exceeding the supply, non-physicians could be part of the solution to meet the demands for CRC screening.
在过去二十年中，对结肠镜筛查的需求持续上升。因此，目前的胃肠病学医生队伍无法满足结直肠癌（CRC）筛查的需求。所以，需要解决方案来改善这种差距，非医师内镜检查人员是一个潜在的选择。然而，目前关于非医师在内镜检查中表现的文献有限。本研究的目的是评估三名接受过胃肠病学 fellowship 培训的执业护士（NPs）进行结肠镜检查的质量。
这是一项在单一的三级学术医疗中心进行的回顾性研究。对三名经过胃肠病学专业培训的 NPs 在完成至少 140 次监督下的结肠镜检查培训后所进行的结肠镜检查进行回顾分析。纳入标准是因结直肠癌筛查目的而接受结肠镜检查的患者。结果包括美国胃肠内镜学会/美国胃肠病学会特别工作组（ASGE/ACG）特别工作组定义的结肠镜检查质量指标。
该研究纳入了 1012 名接受三名 NPs 进行筛查结肠镜检查的受试者（平均年龄 56.2 岁，女性占 51.5%，非裔美国人占 73.9%）。997 名受试者（98.5%）成功完成了盲肠插管。平均腺瘤检出率为 35.6%。平均退镜时间为 18.9 分钟。没有发生包括结肠穿孔或息肉切除术后延迟出血在内的不良事件。
美国三名接受过 fellowship 培训的结肠镜检查 NPs 满足了 ASGE/ACG 特别工作组提出的质量指标，表明经过充分培训的 NPs 可以安全有效地进行结肠镜检查。鉴于结肠镜检查的需求超过了供应，非医师可以成为满足 CRC 筛查需求的解决方案的一部分。
