Experience of a Nurse Practitioner Performing Colonoscopy at a Tertiary Center in the United States
2Director of Therapeutic Endoscopy, Associate Professor of Medicine, The Johns Hopkins Hospital, Division of Gastroenterology, 1800 Orleans Street, Sheikh Zayed lower, Suite 7125B, Baltimore, Maryland 21287, USA
- *Corresponding Author:
- Monica Riegert
DNP, CRNP, The Johns Hopkins Hospital
Division of Gastroenterology
600 N. Wolfe St, Blalock 402, Baltimore, 21287, USA
E-mail: [email protected]
Received date: May 11, 2015; Accepted date: June 06, 2015; Published date: June 15, 2015
Citation: Riegert ML, Khasab MA, Kalloo AN (2015) Experience of a Nurse Practitioner Performing Colonoscopy at a Tertiary Center in the United States . J Gastrointest Dig Syst 5:298. doi:10.4172/2161-069X.1000298
Copyright: © 2015 Riegert M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium; provided the original author and source are credited.
Background: The majority of the literature that involves non-physician endoscopists pertains to the performance of flexible sigmoidoscopy, with only limited reports of their performance of colonoscopy. Recent ASGE guidelines stated that there is insufficient data to support non-physician endoscopists to perform colonoscopy.
Objective: To assess the performance of a fellowship-trained nurse practitioner (NP) in colonoscopy.
Methods: The NP's performance was evaluated using quality indicators for colonoscopy as defined by the ASGE/ACG Taskforce, including appropriate indication, informed consent, appropriate surveillance interval, documentation of bowel preparation quality, photo documentation of cecal landmarks, cecal intubation rate, adenoma detection rate (ADR), withdrawal time, and incidence of procedure-related complications.
Results: The study included 300 consecutive subjects (mean age 55.4 years, female 48.3%, African American 84.6%) who underwent average risk screening colonoscopies. A total of 385 polyps were detected for a mean polyp detection rate of 1.28 per colonoscopy. The overall adenoma detection rate was 35.0%, with 41.3% detection in men and 28.3% detection in females. Cecal intubation was successful in 297 (99.0%) subjects. The mean withdrawal time was 19.3 minutes (range 6.7-66.7 minutes). There were no adverse events including colonic perforations or post-polypectomy bleeding.
Conclusion: We describe the technical and cognitive performance of a non-physician in colonoscopy in the United States. The NP adequately satisfied all of the quality indicators proposed by the ASG/ACG Taskforce. With the demand for screening colonoscopies exceeding the supply of qualified providers, non-physicians could be a potential solution to increasing the capacity of endoscopists needed to perform CRC screening. However, non-physicians, similar to physicians, should be subjected to a quality monitoring program.