Comparisons of Screening Colonoscopy Performed by a Nurse Practitioner and Gastroenterologists A Single-Center Randomized Controlled Trial

Several barriers to colorectal cancer screening have been identified including limited access to trained endoscopists and highlight insufficient capacity to meet projected demand for colonoscopies. Two European studies have found that nonphysician providers can perform colonoscopies as safely and accurately as physicians. Training nurse practitioners (NP) to perform colonoscopy may be an effective strategy to increase access. The goal of this study was to compare accuracy, safety, and patient satisfaction in screening colonoscopy performed by board certified gastroenterologists (GI-MD) and a gastroenterology trained nurse practitioner (GI-NP). A consecutive sample of average risk participants referred for screening colonoscopy was randomized to have their procedure performed by either a GI-MD (n = 100) or a GI-NP (n = 50). Participants completed a preprocedure and postprocedure questionnaire. Endoscopists completed a postprocedure questionnaire. Cecal intubation rates, duration of procedure, sedative, and analgesic use, and patient reported procedural pain scores were equivalent among the groups. The GI-NP group had a higher adenoma detection rate compared with the combined GI-MD groups (42% and 17%, respectively, p = .0001) and a higher satisfaction score when compared with the combined GI-MD groups (mean 5.9 +/- 13.81 and 8.6 +/- 16.11, respectively, p = .042; visual analog scale 0-100 mm, 0 = completely satisfied, 100 = completely dissatisfied). There were no immediate complications reported in any group. The properly trained GI-NP in our study performed screening colonoscopy as safely, accurately, and satisfactorily as the GI-MDs. Using well-trained NPs for screening colonoscopy can be an effective strategy to increase access to colorectal screening.