Endoscopy by nonphysicians

Abstract

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical literature was performed by using PubMed, supplemented by accessing the “related articles” feature of PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines are drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations were based on reviewed studies and were graded on the strength of the supporting evidence (Table 1). 1 Guyatt G. Sinclair J. Cook D. et al. Moving from evidence to action. Grading recommendations: a qualitative approach. in: Guyatt G. Rennie D. Users' guides to the medical literature. AMA Press, Chicago2002: 599-608 Google Scholar Table 1Grades of recommendation Grade of recommendation Clarity of benefit Methodologic strength supporting evidence Implications 1A Clear Randomized trials without important limitations Strong recommendation; can be applied to most clinical settings 1B Clear Randomized trials with important limitations (inconsistent results, nonfatal methodologic flaws) Strong recommendation; likely to apply to most practice settings 1C+ Clear Overwhelming evidence from observational studies Strong recommendation; can apply to most practice settings in most situations 1C Clear Observational studies Intermediate-strength recommendation; may change when stronger evidence is available 2A Unclear Randomized trials without important limitations Intermediate-strength recommendation; best action may differ depending on circumstances or patients' or societal values 2B Unclear Randomized trials with important limitations (inconsistent results, nonfatal methodologic flaws) Weak recommendation; alternative approaches may be better under some circumstances 2C Unclear Observational studies Very weak recommendation; alternative approaches likely to be better under some circumstances 3 Unclear Expert opinion only Weak recommendation; likely to change as data become available Adapted from Guyatt et al. 1 Guyatt G. Sinclair J. Cook D. et al. Moving from evidence to action. Grading recommendations: a qualitative approach. in: Guyatt G. Rennie D. Users' guides to the medical literature. AMA Press, Chicago2002: 599-608 Google Scholar Open table in a new tab Adapted from Guyatt et al. 1 Guyatt G. Sinclair J. Cook D. et al. Moving from evidence to action. Grading recommendations: a qualitative approach. in: Guyatt G. Rennie D. Users' guides to the medical literature. AMA Press, Chicago2002: 599-608 Google Scholar Studies of nurses performing colonoscopy have been performedGastrointestinal EndoscopyVol. 71Issue 7PreviewWe read with great interest the recent American Society for Gastrointestinal Endoscopy guideline of “Endoscopy by non-physicians” in which the authors concluded that “there are insufficient data to support non-physician endoscopists to perform colonoscopy and upper endoscopy, level 3 (expert opinion only).”1 We respectfully disagree with such a recommendation. In 2003, in the pages of the Journal, we reported that nurse endoscopists, using colonoscopes, were able to reach the cecum safely in patients who were scheduled to have only a sigmoidoscopy for colorectal screening. Full-Text PDF