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

BACKGROUND : In Sweden, a nationwide colorectal cancer (CRC) screening program for individuals aged 60-74 started in 2021; to meet the increasing demand for colonoscopy, nurse endoscopists may play a key role - provided they maintain high technical quality. This observational study aimed to evaluate the nurse endoscopists' performance in the screening program, focusing on core quality indicators. METHODS : Data were extracted from the Swedish Quality Register for Colonoscopies and Colorectal Cancer Screening (SveReKKS), including all screening colonoscopies performed between 1 April 2019 and 31 August 2025. Key quality indicators - adenoma detection rate (ADR), cecal and ileal intubation rates, bowel preparation, sedation use, and complications - were compared between nurse and physician endoscopists using generalized linear mixed-effects models with a logit link. RESULTS : Of 27 978 colonoscopies, 42 % were performed by nurses. Nurses had a higher ADR (57 % vs. 46 %; odds ratio [OR] 1.55, 95 %CI 1.47-1.62), and 3.6 % of the nurses had an ADR < 25 %, compared with 11.2 % of the physicians. Nurses also had higher odds of ileal intubation (OR 1.2, 95 %CI 1.1-1.2) and longer withdrawal times. CONCLUSIONS : Nurse endoscopists demonstrated high quality colonoscopy performance in CRC screening and represent a valuable resource to meet increasing service demands without compromising clinical standards.