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

Key Takeaways for GI Nurses

• In this large Swedish population-based screening cohort of nearly 28,000 colonoscopies, nurse endoscopists performed 42% of procedures and achieved a higher adenoma detection rate (ADR) than physicians (57% vs. 46%), demonstrating that well-trained nurse endoscopists can meet and exceed benchmark quality indicators in CRC screening.
• Only 3.6% of nurse endoscopists fell below the critical ADR threshold of 25%, compared with 11.2% of physicians — reinforcing that structured training, credentialing, and quality monitoring can produce highly consistent performance among nurse proceduralists.
• These findings support an evidence-based case for expanding nurse endoscopist roles to help address growing colonoscopy capacity demands as national screening programs scale up.
• Robust, standardized data collection (via registries such as SveReKKS) is central to validating nurse-led endoscopy and should inform local quality assurance programs and credentialing pathways in GI units.

Clinical Relevance

This study offers strong, registry-based evidence that nurse endoscopists can deliver high-quality, safe colonoscopy within a structured population screening program. The adenoma detection rate — widely regarded as the single most important quality indicator because of its link to interval cancer prevention — was not only comparable but statistically higher among nurses than physicians. For GI and endoscopy nursing teams, this reinforces that technical competency in colonoscopy is achievable and sustainable with appropriate training, certification, and ongoing performance review, rather than being inherently tied to medical degree status.

From an operational standpoint, these findings have direct implications for staffing models, workforce planning, and procedural scheduling in endoscopy units facing rising screening volumes. As national CRC screening programs like Sweden's expand eligibility and demand, units can use this evidence to advocate for or strengthen nurse endoscopist training pathways, knowing that quality metrics—ADR, cecal/ileal intubation rates, and complication rates—can be maintained at a high standard. This supports more flexible deployment of clinical staff, potentially reducing waiting times for screening colonoscopy without compromising detection quality or patient safety.

For professional development, this research validates investment in formal nurse endoscopist training programs, mentorship, and competency-based credentialing frameworks. It also underscores the importance of quality registries and audit systems in holding all endoscopists — regardless of professional background — to the same rigorous quality benchmarks. Units considering or currently employing nurse endoscopists should use these data to support continuous quality improvement initiatives, structured performance feedback, and transparent reporting of individual and team-level quality indicators, which ultimately strengthens patient trust and safety culture within the endoscopy suite.

Bottom Line

This large Swedish screening cohort demonstrates that appropriately trained nurse endoscopists can achieve adenoma detection rates and quality indicators equal to or exceeding those of physicians, providing strong evidence to support and expand nurse-led colonoscopy roles as CRC screening programs scale to meet increasing procedural demand.