Lee CK, Park DI, Lee SH, Hwangbo Y, Eun CS, Han DS, Cha JM, Lee BI, Shin JE. Participation by experienced endoscopy nurses increases the detection rate of colon polyps during a screening colonoscopy: a multicenter, prospective, randomized study.
Gastrointest Endosc 2011;
74:1094-102. [PMID:
21889137 DOI:
10.1016/j.gie.2011.06.033]
[Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 06/23/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND
No reported prospective, randomized study has evaluated the impact of an endoscopy nurse participating as a second observer during colonoscopy.
OBJECTIVE
To determine whether the participation of an endoscopy nurse enhanced the polyp detection rate (PDR) and adenoma detection rate (ADR) during screening colonoscopy.
DESIGN
Multicenter, prospective, randomized study.
SETTING
Academic hospitals.
PATIENTS
A total of 844 consecutive patients undergoing screening colonoscopy.
INTERVENTIONS
Single observation by colonoscopist or dual observation by colonoscopist and endoscopy nurse during colonoscope withdrawal.
MAIN OUTCOME MEASUREMENTS
PDR and ADR.
RESULTS
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.
LIMITATIONS
Absence of colonoscopist blinding.
CONCLUSIONS
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.
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