title: Comparison of colonoscopic performance between medical and nurse endoscopists: a non-inferiority randomised controlled study in Asia.
abstract: OBJECTIVE
  To test the hypothesis that trained nurse endoscopists are not inferior to medical endoscopists in finding adenomas during colonoscopy.
  
  
  METHODS
  This is a prospective, randomised, single-blind, non-inferiority study comparing nurses with medical endoscopists in performing screening colonoscopy. The nurse endoscopists had been trained according to the British Joint Advisory Group on GI Endoscopy curriculum and had completed at least 140 colonoscopic procedures prior to the study. The primary endpoint was the adenoma detection rate. Secondary endpoints included the caecal intubation rate, intubation time, complication rate, patient pain and satisfaction scores.
  
  
  RESULTS
  We enrolled and analysed a total of 731 patients over a 15-month period. At least one adenoma was found in 159 (43.8%) of 363 patients by nurse endoscopists and 120 (32.7%) of 367 patients by medical endoscopists and a proportion difference of +11.1% compared with the medical endoscopists (95% CI 4.1% to 18.1%). The withdrawal time was, however, significantly longer among nurses (998 vs 575 s, p<0.001). After adjusting for differences in a regression analysis, colonoscopy by nurses was associated with a lower adenoma detection rate (OR 0.475: 95% CI 0.311 to 0.725). Nurse endoscopists had a lower caecal intubation rate (97.3% vs 100%), received better pain and satisfaction scores and had a high rate of patient acceptance.
  
  
  CONCLUSIONS
  In this pragmatic trial, nurses can perform screening colonoscopy but require a longer procedural time to achieve a comparable adenoma detection rate as medical endoscopists.
  
  
  BACKGROUND
  NCT01923155.
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong.
authors.forename: Aric J
authors.identifier: http://orcid.org/0000-0003-2150-5713
authors.initials: AJ
authors.lastname: Hui
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: James Y
authors.initials: JY
authors.lastname: Lau
authors.affiliation: Combined Endoscopy Unit, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong.
authors.forename: Phyllis P Y
authors.initials: PP
authors.lastname: Lam
authors.affiliation: Combined Endoscopy Unit, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong.
authors.forename: Alman O M
authors.initials: AO
authors.lastname: Chui
authors.affiliation: Combined Endoscopy Unit, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong.
authors.forename: Alice S H
authors.initials: AS
authors.lastname: Fan
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Thomas Y T
authors.initials: TY
authors.lastname: Lam
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Yee-Kit
authors.initials: YK
authors.lastname: Tse
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Raymond S Y
authors.initials: RS
authors.lastname: Tang
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Siew C
authors.initials: SC
authors.lastname: Ng
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Justin C Y
authors.initials: JC
authors.lastname: Wu
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Jessica Y L
authors.initials: JY
authors.lastname: Ching
authors.affiliation: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Francis K L
authors.initials: FK
authors.lastname: Chan
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sung
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D002983:Clinical Competence; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000451:nursing / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D016037:Single-Blind Method; D013041:Specialties, Nursing
keywords: colonoscopy; colorectal cancer screening; nurse endoscopist