1. Flexible sigmoidoscopy. “The performance of flexible sigmoidoscopy for colorectal cancer screening by nonphysician endoscopists is supported when intensive training occurs by a certified endoscopist,” the guideline states.
The ASCE explains that nonphysician endoscopists have been performing sigmoidoscopy since the 1970s. The procedure requires fewer supervised examinations to attain objective measures of technical competency than other endoscopic procedures. It does not require sedation and is associated with an inherently low complication rate.
2. Video capsule endoscopy. “There are data to support the use of nonphysician personnel to pre-read video capsule endoscopy when subsequent review occurs by a trained physician,” the guideline states.
Reviewing of VCE examinations is a time-intensive process and several studies have demonstrated nonphysicians’ ability to identify significant endoscopic abnormalities is similar to that of physicians, the ASCE says. There are also significant cost savings when procedures are pre-read by a nonphysician reader.
3. Colonoscopy and upper endoscopy. “There are insufficient data to support nonphysician endoscopists to perform colonoscopy and upper endoscopy,” the guideline states.
Requirements for both procedures are much more challenging than for flexible sigmoidoscopy, the ASCE says. The nonphysician would have to manage sedation, recognize findings, understand disease processes and perform endoscopic therapy when necessary. They must also recognize potential complications and the need for therapy. These skills require prolonged, intensive training.
Where nonphysicians are capable of carrying out a procedure, they still need to undergo intensive training under close supervision by a physician endoscopist, the ASCE says. And then the trained nonphysician endoscopists should work under a physician’s supervision. Nurse practitioners and physician assistants generally carry their own malpractice insurance, but registered nurses keep in mind that registered nurses work under supervising physician’s medical license.
See the ASGE guidelines for endoscopy by nonphysicians (pdf).
