The Role of Gastrointestinal (GI) Endoscopy Nurse Guide

An estimated 22.2 millions gastrointestinal endoscopies are performed in the U.S. each year.¹ Gastrointestinal endoscopic procedures serve both diagnostic and interventional purposes.² They involve gastroscopies, which entail inserting a scope into the esophagus, stomach, and first section of the small intestine, and colonoscopies, which require the scope to be inserted into the large intestine. The crucial role of nurses in these procedures cannot be understated, and in this article, we will shed light on their involvement in gastrointestinal endoscopy. 

The European Society of Gastroenterology and Endoscopy Nurses and Associates has established a core curriculum for nurses working in these settings.³ Taking that more and more procedures are being performed in endoscopic rooms, in replacement of open surgery, nurses are also required to keep their knowledge and skills up to date after initial training.³ 

Overall, nurses working in gastrointestinal endoscopy have two main roles: assisting the endoscopist during procedures and provide specialised patient care before, during and after the procedure.^4,5 

Nurse endoscopists have been established in several European Union countries, and studies have demonstrated that they are as competent as physicians when performing these procedures.⁵ The training program for nurse endoscopists usually lasts for one year and is university-based.⁵

Moderate sedation is typically used as the standard method of sedation for most endoscopic procedures.⁸ The role of nurses in endoscopy sedation has evolved over time and differs across countries, ranging from administering single drugs to combinations of benzodiazepines and opioids, and in some cases, even nurse-led propofol administration.⁸

Guidelines for Sedation in GI endoscopy have been developed in 2018.⁹ These guidelines highlight the importance of patient monitoring during endoscopy sedation. Mandatory monitoring includes:⁹

• Heart rate
• Blood pressure
• Pulse oximetry
• Level of consciousness
• Ventilatory status
• Continuous electrocardiogram for patients with cardiovascular disease or dysrhythmia

The guideline does not include capnography in mandatory monitoring of endoscopy procedures. However, capnography has been recommended by the Association of Anaesthetists of Great Britain and Ireland.¹⁰ The association recommends that continuous waveform capnography should be used to monitor adequacy of ventilation for all patients undergoing moderate or deep sedation, and should be available wherever any patients undergoing moderate or deep sedation are recovered and additionally where multiple drugs/anaesthetic drug techniques are used, and pre-assessment highlights increased clinical risk.¹⁰

Sedation adverse events and complications are known to occur; these are more likely depending on the type, dose and mode of administration of sedative drugs, patient’s age and underlying chronic conditions.⁸ Medication side effects, like hypotension, desaturation, bradycardia, hypertension, arrhythmia, aspiration, respiratory depression, vomiting, cardiac arrest, respiratory arrest, angina, hypoglycaemia, and/or allergic reaction, have been reported.⁸ Nurses involved in sedation practice must have adequate training to administer sedative medications, monitor the patient throughout the procedure and recover from possible complications.⁸

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