Colonoscopy quality indicators among nurse endoscopists and physicians in population-based colorectal cancer screening in Sweden.

BACKGROUND

In Sweden, a nationwide colorectal cancer (CRC) screening program for individuals aged 60-74 started in 2021; to meet the increasing demand for colonoscopy, nurse endoscopists may play a key role - provided they maintain high technical quality. This observational study aimed to evaluate the nurse endoscopists' performance in the screening program, focusing on core quality indicators.

METHODS

Data were extracted from the Swedish Quality Register for Colonoscopies and Colorectal Cancer Screening (SveReKKS), including all screening colonoscopies performed between 1 April 2019 and 31 August 2025. Key quality indicators - adenoma detection rate (ADR), cecal and ileal intubation rates, bowel preparation, sedation use, and complications - were compared between nurse and physician endoscopists using generalized linear mixed-effects models with a logit link.

RESULTS

Of 27 978 colonoscopies, 42 % were performed by nurses. Nurses had a higher ADR (57 % vs. 46 %; odds ratio [OR] 1.55, 95 %CI 1.47-1.62), and 3.6 % of the nurses had an ADR < 25 %, compared with 11.2 % of the physicians. Nurses also had higher odds of ileal intubation (OR 1.2, 95 %CI 1.1-1.2) and longer withdrawal times.

CONCLUSIONS

Nurse endoscopists demonstrated high quality colonoscopy performance in CRC screening and represent a valuable resource to meet increasing service demands without compromising clinical standards.