Colonoscopies performed by specially trained nurses as part of the Swedish bowel cancer screening programme are of at least the same quality as those performed by doctors, according to a study from Karolinska Institutet published in the journal Endoscopy. The results suggest that nurses could help to address the increasing demand for examinations within the national screening programme.
Colorectal cancer is one of the most common forms of cancer in Sweden. For the past few years, there has been a national screening programme aimed at people aged between 60 and 74. Those who receive a positive result from a stool test are offered a follow-up colonoscopy to examine the inside of the bowel.
Photo: Charlotta Wadenbrant, Capio St Göran.
“As more and more people are offered bowel cancer screening, there is a greater need for endoscopists,” says Anna Forsberg , consultant at the Endoscopy Centre, Capio St Göran’s Hospital, and docent at the Department of Medicine, Solna , Karolinska Institutet. “Our results show that specially trained nurses can perform colonoscopies to a high standard and help to meet the increased demand.”
The researchers analysed data from the national quality register SveReKKS. The study included a total of nearly 28,000 colonoscopies performed between April 2019 and August 2025. Of these, 42 per cent were carried out by nurses and 58 per cent by doctors. The study included 55 nurses and 170 doctors.
High quality in screening colonoscopies
An important international measure of quality is how often an endoscopist detects adenomas (polyps that can develop into cancer). The nurses detected adenomas in 57 per cent of examinations, compared to 46 per cent for doctors. After adjusting for factors such as age, sex, and the endoscopist’s experience, the nurses were still more likely to detect adenomas.
Eleven per cent of the doctors and four per cent of the nurses had a detection rate below the minimum level recommended for endoscopists in screening programmes.
The researchers found no clear differences between the groups in the detection of cancer or advanced adenomas, nor was there any difference in the proportion of complete examinations. The rate of complications was low for both nurses and doctors. No screening-related deaths were reported during the study period.
Specially trained nurses strengthen healthcare
In Sweden, nurses have been performing colonoscopies since 2006. Certification requires completion of a one-year part-time training programme comprising both theoretical and practical components, and the role involves taking on independent professional responsibility throughout the care process. Currently, there are over 100 certified nurses in Sweden, but their distribution across the country is uneven, which may have affected the results.
The study was carried out by researchers from Karolinska Institutet, the University of Gothenburg, Uppsala University and Södersjukhuset, as well as the Colonoscopy Research Sweden (CRS) collaboration. It was funded by the Swedish Cancer Society and Region Stockholm (ALF funding). The researchers state that they have no conflicts of interest.
Publication
“Colonoscopy quality indicators among nurse endoscopists and physicians in population-based colorectal cancer screening in Sweden “. Anna M Forsberg, Jóhann P. Hreinsson, Peter T Schmidt, CRS (Colonoscopy Research Sweden), Johannes Blom, Endoscopy, online October 7, 2026, doi: 10.1055/a-2949-7463
