Endoscopy by nurses is safe and effective, but probably not cost-effective

News release from the National Coordinating Centre for Health Technology Assessment

20 October 2006

New research commissioned by the HTA programme suggests that there is little difference between nurses and doctors in performing diagnostic endoscopy. The research, published in the Health Technology Assessment journal series this week [http://www.hta.ac.uk/project.asp?PjtId=1155], shows that nurses are also more thorough, and patients are significantly more satisfied after endoscopy by a nurse. Researchers also found however, that although the costs associated with endoscopy by doctors are higher, overall endoscopy conducted by doctors is likely to be more cost-effective.

Led by Professor John Williams of the University of Wales, the study was undertaken in 23 hospitals in England, Scotland and Wales. Sixty-seven doctors and 30 nurses took part, along with almost 2,000 patients. Researchers aimed to compare the clinical and cost-effectiveness of doctors and nurses undertaking upper and lower gastrointestinal endoscopy, measuring acceptability to patients, quality of the process and NHS resource use. An economic model was also developed to allow researchers to investigate the effect of an increase in nurse endoscopists in terms of human resources and training implications.

The research team found that there was no statistically significant difference between doctors and nurses in their clinical effectiveness in diagnostic endoscopy. However, nurses were significantly more thorough in the examination of the oesophagus and stomach, and patients were significantly more satisfied after endoscopy by a nurse. In this research there was no significant difference in costs to the NHS or patients, although the overall cost when undertaken by doctors was slightly more. Even so the economic evaluation, taking account of uncertainty in both costs and quality of life, suggested that endoscopy by doctors has an 87% chance of being more cost-effective than endoscopy by nurses.

“Nurses are increasingly undertaking both upper and lower gastrointestinal endoscopy, and while previous evidence suggests that nurse endoscopists are highly competent, ours was the first randomised controlled trial to investigate this change in role,” says Professor Williams. “Our research highlights several points for debate and shows that the move to nurse endoscopy is safe and effective and liked by patients, however the changes seen in recent years won’t result in cost savings to the NHS and may slightly worsen overall outcomes for patients.”

Notes for editors


  1. The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with more than 400 issues published to date. The journal’s 2007 Impact Factor (3.87) ranked it in the top 10 per cent of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.
  2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility.  The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training.  Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk

Contact details

Naomi Stockley, Programme Manager (Communications)
Telephone: 02380 595 646, Email: ns5@soton.ac.uk

Helen Nikandrou, Assistant Programme Manager (Communications)
Telephone: 02380 595 584, Email: h.nikandrou@soton.ac.uk

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