Association of active endoscopy nurse participation with adenoma detection during screening colonoscopy: a retrospective cohort study

Abstract Background and aim The adenoma detection rate (ADR) is a key quality indicator for screening colonoscopy. Although optimized teamwork during endoscopy may improve mucosal inspection and lesion recognition, real-world evidence on active endoscopy nurse participation remains limited. This study aimed to examine the association between an enhanced nurse-participation workflow and adenoma detection outcomes during screening colonoscopy. Methods This retrospective single-center cohort study included 361 consecutive adults who underwent screening colonoscopy between January 2021 and December 2022. Based on standardized nursing documentation and procedure logs, cases were classified as conventional assistance (n = 223) or enhanced nurse participation (n = 138). The enhanced workflow involved active withdrawal observation, verbal prompting regarding incompletely visualized areas, patient repositioning, lesion image capture, and procedural coordination by nurses who had completed local unit training in lesion recognition and withdrawal-quality metrics. The primary outcome was ADR. Baseline characteristics, detection outcomes, and procedural quality indicators were compared between groups. Key proportions are additionally reported with 95% confidence intervals (CIs) and absolute between-group differences. An exploratory multivariable logistic regression model was used to assess factors associated with adenoma detection. Results Baseline demographic and pre-procedure characteristics were comparable between groups. ADR was higher in the enhanced nurse participation group than in the conventional assistance group (38.4%, 95% CI 30.7-46.7 vs 25.6%, 95% CI 20.3-31.7; absolute difference 12.8 percentage points, 95% CI 3.0-22.7; P = 0.014). PDR was also higher (54.3% vs 41.7%; absolute difference 12.6 percentage points, 95% CI 2.1-22.9; P = 0.019). Mean withdrawal time was longer in the enhanced workflow group (9.1 +/- 1.6 vs 7.8 +/- 1.4 minutes, P =8 minutes. Conclusion An enhanced nurse-participation workflow was associated with higher adenoma detection during screening colonoscopy. Because the intervention also involved longer withdrawal time and other process changes, and because residual operator- and workflow-level confounding cannot be excluded, these findings should be interpreted as hypothesis-generating rather than causal. Prospective multicenter studies are warranted.