Stuttgart, October 7, 2026 – A nationwide Swedish registry study by Anna M. Forsberg, MD, et al., published in Endoscopy (Georg Thieme Verlag, Stuttgart. 2026), revealed that trained nurses performed screening colonoscopies at a high-quality level, comparable to physician endoscopists. Across nearly 28,000 procedures, nurses even had slightly higher odds of detecting adenomas than physicians, while the detection of advanced adenomas and colorectal cancer demonstrated comparable outcomes. The findings indicate a pragmatic approach to expanding screening capacity without compromising core quality indicators or patient safety.
Colorectal cancer screening programs depend on timely access to colonoscopy. As more people become eligible for screening, health systems need enough qualified endoscopy staff to meet demand while maintaining quality standards. The Swedish data suggest that specially trained nurse endoscopists can be part of the solution to this problem.
The observational study utilized data from the Swedish national quality register for colonoscopies and colorectal cancer screening, SveReKKS. The study’s strength lies in its national registry design and large real-world dataset. It reflects the performance of colonoscopies within the context of an organized screening program as opposed to a single-center or highly selected setting. The study included all screening colonoscopies performed between April 1, 2019, and August 31, 2025, among individuals aged 60 to 74 years in Sweden’s national colorectal cancer screening program.
Nurses demonstrate higher odds of adenoma detection
The analysis compared the performance of nurse endoscopists and physician endoscopists across 27,978 screening colonoscopies. The primary quality focus included adenoma detection rate, cecal and ileal intubation rates, bowel preparation, sedation use, and complications. Adenomas are benign precursor lesions that can evolve into colorectal cancer over time, making their detection a key indicator for the quality of screening colonoscopies.
Nurse endoscopists showed higher adjusted odds of adenoma detection than physicians, with an odds ratio of 1.39 and a 95 percent confidence interval ranging from 1.13 to 1.71. The adjusted odds ratio was 1.15 for advanced adenomatous lesions and 1.10 for colorectal cancer, indicating that nurse endoscopists were as effective as physicians in detecting these lesions and colorectal cancer in this screening setting.
Capacity matters, but quality remains the benchmark
“For patients, the key message is not that one professional group should replace another. Our findings support a team-based model in which trained nurse endoscopists can help provide screening colonoscopies as demand rises,” says Anna M. Forsberg, MD, PhD, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. “Expanding capacity must not come at the expense of patient safety, though. It should mean training, monitoring, and maintaining the same safety and quality expectations for everyone performing colonoscopies.”
The full study, “Colonoscopy quality indicators among nurse endoscopists and physicians in population-based colorectal cancer screening in Sweden”, is published in Endoscopy.