Accuracy of polyp detection by gastroenterologists and nurse endoscopists during flexible sigmoidoscopy: A randomized trial

Background & Aims: The use of nurse endoscopists to perform flexible sigmoi doscopy is expanding, increasing the availability of colorectal cancer scre ening. However, the effectiveness of this practice has not been studied in randomized trials. The aim of this trial was to examine the miss rate of po lyps, the depth of sigmoidoscope insertion, and the incidence of complicati ons during flexible sigmoidoscopy performed by nurse endoscopists and by ga stroenterologists. Methods: Three hundred twenty-eight patients were random ized to undergo screening flexible sigmoidoscopy performed by a nurse endos copist or by a gastroenterologist. Frequency of missed polyps was determine d by repeat sigmoidoscopy, performed by a gastroenterologist blinded to the identity of the first endoscopist. Multiple logistic regression analysis i dentified characteristics associated with missed polyps. Results: Gastroent erologists and nurse endoscopists had equivalent miss rates for adenomatous polyps (20% vs. 21%, respectively; P = 0.91). No complications occurred in any patient. Gastroenterologists inserted the sigmoidoscope further than n urse endoscopists (61 vs. 55 cm, respectively; P < 0.00001). Polyp location in the descending colon (odds ratio, 4.1; 95% confidence interval, 1.7-10. 3) was highly associated with missed polyps. Conclusions: No differences in detection of adenomatous polyps or frequency of complications were found. These data suggest that experienced nurse endoscopists may perform screenin g flexible sigmoidoscopy as safely and as effectively as gastroenterologist s.