Is the Development of a Nurse Colonoscopy Service Safe and Worthwhile?

Abstract

Is the Development of a Nurse Colonoscopy Service Safe and Worthwhile? Ananandapuram D. Dwarakanath, Andrew R. Tanner, Colm Hennessey, Mohammed Tabaqchali, Lindsay Hurst INTRODUCTION: The need for high quality examination of the colon is increasing in the UK, fuelled by ‘‘2 week rule’’ for cancer diagnosis, rapid access rectal bleeding clinics, open access colonoscopy service for GPs. We have developed a nurse colonoscopy service (LH) since August 2000. AIMS& METHODS: To assess the impact and diagnostic yield of a nurse colonoscopy service between August 2000 and 2003. The findings, caecal intubation rate and complication rate were reviewed retrospectively from the computer record. RESULTS: Number of colonoscopies performed by LH were 481 of 1834(26%), 671 of 1916(35%) and 771 of 2032(38%). The crude caecal intubation rate was 85%,82% and 82%; but when ‘‘corrected’’ for obstructing lesions and poor prepartion the rates were 92%, 91% and 90%. The findings at colonoscopy are shown in the table. There were no serious complications with diagnostic and therapeutic procedures. CONCLUSIONS: 1.Nurse colonoscopy is safe 2.A well trained nurse colonoscopist can achieve caecal intubation rates of 90%, with 40% of procedures showing some abnormality. 3.The through-put and waiting times for the unit have improved. We recommend this service development as the demand for colonoscopy increases, as population screening for colon cancer develops. **680 Barrett's Esophagus (BE) Is Common in Older Patients Undergoing Screening Colonoscopy Regardless of Gastroesophageal Reflux (GER) Symptoms Kenneth R. DeVault, Eric M. Ward, Herbert C. Wolfsen, David S. Loeb, Murli Krishna, Lois L. Hemminger, Sami R. Achem Although GER and BE are the precursor of most, if not all cases of esophageal adenocarcinoma (ACA), most patients with ACA present outside of a BE surveillance program. This could either be due to undiagnosed symptomaticGER/ BE or due to BE/ACA occurring in patients without GER symptoms. We are studying the prevalence of BE and GER symptoms in older patients referred for screening or polyp surveillance colonoscopy. Methods: Patients referred for outpatient colonoscopy are eligible if they are at least 65 years old and have previously not undergone upper endoscopy. The patients completed detailedGER questionnaires including an instrument previously validated in patients presenting for upper endoscopy (AJG 2001;96:2005) and a series of four simple, clinically oriented questions inquiring about presence, frequency and duration of heartburn and regurgitation. During the research endoscopy, the endoscopist recorded the squamocolumnar junction (SCJ) as either long segment (>2 cm)BE (LSBE), short segment BE (<2cm) (SSBE) or normal. If the SCJ was felt to be ‘‘irregular’’ the endoscopist was asked to predict, in their judgment, if BEwas present. All patients had biopsies of either the BE segment or below a normal appearing SCJ, which were read by a dedicated pathologist blinded to the source of the biopsy. Intestinal metaplasia of the cardia (IMC) was considered present if the SCJ was normal and intestinalmetaplasia was found on biopsy.Results: 200 patients have been studied. Percentage of LSBE, SSBE and IMC in total and by gender are in the table. The validated questionnaire did not predict the presence of BE even when lower symptom cut-offs were used. Using the 4 simple questions, 62 (31%) had symptoms consistent with GER and 138 (69%) did not(NS). 17.8% of the symptomatic and 12.3% of the asymptomatic patients had either SSBE or LSBE (NS). All LSBE patients were asymptomatic by both questionnaires. Conclusions: BE (predominantly SSBE) is common in unscreened patients at least 65 years of age who are referred for colonoscopy. Men were twice as likely to have BE. GER symptoms were common (31%), but a poor predictor of BE when evalutated by either a validated questionnaire or a series of simple questions. Supported by grants from American College of Gastroenterology, AstraZeneca and Mayo Foundation.