Differences with experienced nurse assistance during colonoscopy in detecting polyp and adenoma: a randomized clinical trial

  • Weihong Wang
  • Lu Xu
  • Zhenfei Bao
  • Linyin Sun
  • Chunyan Hu
  • Feng Zhou
  • Lei Xu
  • Dingmei Shi
Original Article



This study aims to evaluate whether the participation of an experienced endoscopy nurse in colonoscopy increases the polyp detection rate (PDR) and adenoma detection rate (ADR) of experienced colonoscopists.


This study was a randomized controlled trial. Patients were randomly assigned to the experienced colonoscopist alone (single observer) group, or experienced nurse participation (dual observer) group. The primary outcome was the PDR and ADR. The advanced lesion detection rate was also recorded.


A total of 587 patients were included in the analysis. Among these patients, 291 patients were assigned to the single observer group, while 296 patients were assigned to the dual observer group. The PDR was 33% in the single observer group and 41.9% in the dual observer group (P = 0.026), while the ADR was 23.0% in the single observer group and 30.4% in the dual observer group (P = 0.043). No significant difference was found for advanced lesions between groups.


The present data demonstrated that experienced nurse observation during colonoscopy can improve polyp and adenoma detection rates, even if the colonoscopist is experienced.


Nurse assistance Polyp detection Adenoma detection, colorectal cancer 



The authors thank Dr. Chunjiu Hu, Dr. Honghui Chen, Dr. Xiaoyun Ding, and Dr. Haizhong Jiang at Ningbo First Hospital, Ningbo, China, for their valuable work in colonoscopy examination and data collection.


This study was supported by the Health and Family Planning Commission of Zhejiang Province (grant nos. 201483560, 2016KYB257,2017KY581). The funding authorities had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30. CrossRefPubMedGoogle Scholar
  2. 2.
    Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O'Brien MJ, Levin B, Smith RA, Lieberman DA, Burt RW, Levin TR, Bond JH, Brooks D, Byers T, Hyman N, Kirk L, Thorson A, Simmang C, Johnson D, Rex DK (2006) Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. CA Cancer J Clin 56(3):143–159 quiz 184-145CrossRefPubMedGoogle Scholar
  3. 3.
    Kaminski MF, Wieszczy P, Rupinski M, Wojciechowska U, Didkowska J, Kraszewska E, Kobiela J, Franczyk R, Rupinska M, Kocot B, Chaber-Ciopinska A, Pachlewski J, Polkowski M, Regula J (2017) Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death. Gastroenterology 153(1):98–105. CrossRefPubMedGoogle Scholar
  4. 4.
    Corley DA, Jensen CD, Marks AR, Zhao WK, Lee JK, Doubeni CA, Zauber AG, de Boer J, Fireman BH, Schottinger JE, Quinn VP, Ghai NR, Levin TR, Quesenberry CP (2014) Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 370(14):1298–1306. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Xu L, Zhang Y, Song H, Wang W, Zhang S, Ding X (2016) Nurse participation in colonoscopy observation versus the colonoscopist alone for polyp and adenoma detection: a meta-analysis of randomized, controlled trials. Gastroenterol Res Pract 2016:7631981. PubMedGoogle Scholar
  6. 6.
    Oh YS, Collins CL, Virani S, Kim MS, Slicker JA, Jackson JL (2013) Lack of impact on polyp detection by fellow involvement during colonoscopy: a meta-analysis. Dig Dis Sci 58(12):3413–3421. CrossRefPubMedGoogle Scholar
  7. 7.
    Nishizawa T, Suzuki H, Takahashi M, Kaneko H, Fujiyama Y, Komatsu H, Nagumo H, Tanaka S, Hibi T (2011) Trainee participation during colonoscopy adversely affects polyp and adenoma detection rates. Digestion 84(3):245–246. CrossRefPubMedGoogle Scholar
  8. 8.
    Friedman M, Arora G, Green J (2011) Fellow involvement during colonoscopy does not reduce adenoma detection rate. Dig Dis Sci 56(3):919. CrossRefPubMedGoogle Scholar
  9. 9.
    Lee CK, Park DI, Lee SH, Hwangbo Y, Eun CS, Han DS, Cha JM, Lee BI, Shin JE (2011) Participation by experienced endoscopy nurses increases the detection rate of colon polyps during a screening colonoscopy: a multicenter, prospective, randomized study. Gastrointest Endosc 74(5):1094–1102. CrossRefPubMedGoogle Scholar
  10. 10.
    Aslanian HR, Shieh FK, Chan FW, Ciarleglio MM, Deng Y, Rogart JN, Jamidar PA, Siddiqui UD (2013) Nurse observation during colonoscopy increases polyp detection: a randomized prospective study. Am J Gastroenterol 108(2):166–172. CrossRefPubMedGoogle Scholar
  11. 11.
    Prachayakul V, Aswakul P, Limsrivilai J, Anuchapreeda S, Bhanthumkomol P, Sripongpun P, Prangboonyarat T, Kachintorn U (2012) Benefit of “transparent soft-short-hood on the scope” for colonoscopy among experienced gastroenterologists and gastroenterologist trainee: a randomized, controlled trial. Surg Endosc 26(4):1041–1046. CrossRefPubMedGoogle Scholar
  12. 12.
    Dellon ES, Lippmann QK, Sandler RS, Shaheen NJ (2008) Gastrointestinal endoscopy nurse experience and polyp detection during screening colonoscopy. Clin Gastroenterol Hepatol 6(12):1342–1347. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kim TS, Park DI, Lee DY, Yoon JH, Park JH, Kim HJ, Cho YK, Sohn CI, Jeon WK, Kim BI, Lim JW (2012) Endoscopy nurse participation may increase the polyp detection rate by second-year fellows during screening colonoscopies. Gut Liver 6(3):344–348. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Rostom A, Jolicoeur E (2004) Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc 59(4):482–486CrossRefPubMedGoogle Scholar
  15. 15.
    Munson GW, Harewood GC, Francis DL (2011) Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule. Gastrointest Endosc 73(3):467–475. CrossRefPubMedGoogle Scholar
  16. 16.
    Peters SL, Hasan AG, Jacobson NB, Austin GL (2010) Level of fellowship training increases adenoma detection rates. Clin Gastroenterol Hepatol 8(5):439–442. CrossRefPubMedGoogle Scholar
  17. 17.
    Munroe CA, Lee P, Copland A, Wu KK, Kaltenbach T, Soetikno RM, Friedland S (2012) A tandem colonoscopy study of adenoma miss rates during endoscopic training: a venture into uncharted territory. Gastrointest Endosc 75(3):561–567. CrossRefPubMedGoogle Scholar
  18. 18.
    Eckardt AJ, Swales C, Bhattacharya K, Wassef WY, Leung K, Levey JM (2009) Does trainee participation during colonoscopy affect adenoma detection rates? Dis Colon Rectum 52(7):1337–1344. CrossRefPubMedGoogle Scholar
  19. 19.
    Wallace MB (2007) Improving colorectal adenoma detection: technology or technique? Gastroenterology 132(4):1221–1223. CrossRefPubMedGoogle Scholar
  20. 20.
    Buchner AM, Shahid MW, Heckman MG, Diehl NN, McNeil RB, Cleveland P, Gill KR, Schore A, Ghabril M, Raimondo M, Gross SA, Wallace MB (2011) Trainee participation is associated with increased small adenoma detection. Gastrointest Endosc 73(6):1223–1231. CrossRefPubMedGoogle Scholar
  21. 21.
    Rogart JN, Siddiqui UD, Jamidar PA, Aslanian HR (2008) Fellow involvement may increase adenoma detection rates during colonoscopy. Am J Gastroenterol 103(11):2841–2846. CrossRefPubMedGoogle Scholar
  22. 22.
    Winawer SJ, Zauber AG (2002) The advanced adenoma as the primary target of screening. Gastrointest Endosc Clin N Am 12(1):1–9CrossRefPubMedGoogle Scholar
  23. 23.
    Lieberman DA, Weiss DG, Harford WV, Ahnen DJ, Provenzale D, Sontag SJ, Schnell TG, Chejfec G, Campbell DR, Kidao J, Bond JH, Nelson DB, Triadafilopoulos G, Ramirez FC, Collins JF, Johnston TK, McQuaid KR, Garewal H, Sampliner RE, Esquivel R, Robertson D (2007) Five-year colon surveillance after screening colonoscopy. Gastroenterology 133(4):1077–1085. CrossRefPubMedGoogle Scholar
  24. 24.
    von Renteln D, Pohl H (2017) Polyp resection-controversial practices and unanswered questions. Clinical and translational gastroenterology 8(3):e76. CrossRefGoogle Scholar
  25. 25.
    van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E (2006) Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 101(2):343–350. CrossRefPubMedGoogle Scholar
  26. 26.
    Choi HN, Kim HH, Oh JS, Jang HS, Hwang HS, Kim EY, Kwon JG, Jung JT (2014) Factors influencing the miss rate of polyps in a tandem colonoscopy study. The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 64(1):24–30CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of GastroenterologyNingbo First HospitalNingboChina
  2. 2.College of MedicineNingbo UniversityNingboChina

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