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Non-physician endoscopists: A systematic review.

Maximilian Stephens¹, Luke F Hourigan¹, Mark Appleyard¹

¹Maximilian Stephens, Luke F Hourigan, Gerald J Holtmann, Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia.

World Journal of Gastroenterology

|May 7, 2015

Summary

Nurse endoscopists perform gastrointestinal (GI) endoscopy safely but are not more cost-effective than physicians. Methodological limitations in studies hinder definitive conclusions on competency and patient satisfaction.

Keywords:

Cost-benefit Nurse endoscopist Outcome parameter Patient satisfaction Service model

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Area of Science:

Gastroenterology
Nursing Practice
Health Services Research

Background:

Nursing staff are increasingly involved in providing gastrointestinal (GI) endoscopy services.
Evidence regarding their safety, competency, and cost-effectiveness is crucial for service planning.

Purpose of the Study:

To systematically review the existing literature on the safety, competency, and cost-effectiveness of nursing staff performing GI endoscopy.
To identify the scope and quality of evidence available on non-physician endoscopists.

Main Methods:

A comprehensive literature search was conducted across multiple databases for publications on nurse endoscopy.
Studies were screened for eligibility and relevance, focusing on primary research with original datasets.
A total of 26 primary research articles, encompassing 28,883 procedures, were included.

Main Results:

Publications peaked between 1999-2001, with most studies focusing on flexible sigmoidoscopy, upper GI endoscopy, and colonoscopy.
While studies suggest safe procedure performance by trained nurse endoscopists, major methodological limitations (e.g., lack of randomization) were noted.
Nurse endoscopists were found to be less cost-effective in the first year compared to physicians, due to increased follow-up needs.

Conclusions:

Contrary to popular belief, nurse-provided endoscopy services are not more cost-effective than standard physician-led models; evidence suggests the opposite.
Significant methodological shortcomings and biases in current research limit the generalizability and validity of findings on the safety and quality of non-medical endoscopists' services.