Non-physician endoscopists: A systematic review

Stephens, Maximillian, Hourigan, Luke F, Appleyard, Mark, Ostapowicz, George, Schoeman, Mark, Desmond, Paul V, Andrews, Jane M, Bourke, Michael, Hewitt, David, Margolin, David A and Holtmann, Gerald J (2015) Non-physician endoscopists: A systematic review. World Journal of Gastroenterology, 21 16: 5056-5071. doi:10.3748/wjg.v21.i16.5056

Author Stephens, Maximillian
Hourigan, Luke F
Appleyard, Mark
Ostapowicz, George
Schoeman, Mark
Desmond, Paul V
Andrews, Jane M
Bourke, Michael
Hewitt, David
Margolin, David A
Holtmann, Gerald J
Title Non-physician endoscopists: A systematic review
Journal name World Journal of Gastroenterology   Check publisher's open access policy
ISSN 2219-2840
Publication date 2015-04-28
Sub-type Critical review of research, literature review, critical commentary
DOI 10.3748/wjg.v21.i16.5056
Open Access Status DOI
Volume 21
Issue 16
Start page 5056
End page 5071
Total pages 16
Place of publication Pleasanton, United States
Publisher Baishideng Publishing Group Co., Limited.
Collection year 2016
Language eng
Formatted abstract
AIM: To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal (GI) endoscopy services.

METHODS: The literature was searched for publications reporting nurse endoscopy using several databases and specific search terms. Studies were screened against eligibility criteria and for relevance. Initial searches yielded 74 eligible and relevant articles; 26 of these studies were primary research articles using original datasets relating to the ability of non-physician endoscopists. These publications included a total of 28883 procedures performed by non-physician endoscopists.

RESULTS: The number of publications in the field of non-specialist gastrointestinal endoscopy reached a peak between 1999 and 2001 and has decreased thereafter. 17/26 studies related to flexible sigmoidoscopies, 5 to upper GI endoscopy and 6 to colonoscopy. All studies were from metropolitan centres with nurses working under strict supervision and guidance by specialist gastroenterologists. Geographic distribution of publications showed the majority of research was conducted in the United States (43%), the United Kingdom (39%) and the Netherlands (7%). Most studies conclude that after appropriate training nurse endoscopists safely perform procedures. However, in relation to endoscopic competency, safety or patient satisfaction, all studies had major methodological limitations. Patients were often not randomized (21/26 studies) and not appropriately controlled. In relation to cost-efficiency, nurse endoscopists were less cost-effective per procedure at year 1 when compared to services provided by physicians, due largely to the increased need for subsequent endoscopies, specialist follow-up and primary care consultations.

CONCLUSION: Contrary to general beliefs, endoscopic services provided by nurse endoscopists are not more cost effective compared to standard service models and evidence suggests the opposite. Overall significant shortcomings and biases limit the validity and generalizability of studies that have explored safety and quality of services delivered by non-medical endoscopists.
Keyword Nurse endoscopist
Service model
Patient satisfaction
Outcome parameter
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Faculty of Medicine and Biomedical Sciences Publications
Official 2016 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 4 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 3 times in Scopus Article | Citations
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