Gastrointestinal endoscopic procedures

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. 

Patients may require a gastrointestinal endoscopy for several reasons:

  • Indigestion
  • Heartburn
  • Repeated vomiting
  • Vomiting blood
  • Difficulty swallowing 
  • Long term abdominal pain 
  • Weight loss 
  • Anaemia
  • Gastric ulcers
  • Coeliac disease
  • Barrett’s oesophagus
  • Foreign bodies or blockages
  • Persistent diarrhoea
  • Changes in bowel movements
  • Rectal bleeding
  • Chron’s disease
  • Polyps

Gastrointestinal Endoscopy Nurses

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.

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 

Advanced Roles in Endoscopy Nursing

Nurses have been taking on two key advanced roles in endoscopy: nurse endoscopists and nurse sedationists.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

Endoscopy Sedation

Irrespective of the type of sedation used, quality management requires pharmacologically appropriate training for all clinical staff involved in sedation practice.3 European and national societies have developed evidence-based and consensus-based guidelines for sedation and monitoring in gastro-intestinal endoscopy that give a comprehensive outline of structural requirements, medication options, patient monitoring and discharge, and the role of endoscopy staff.3

Guidelines for Sedation in GI endoscopy have been developed in 2018.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

Adverse events and complications  

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

About the author

My name is Andreia Trigo RN BSc MSc, I am a nurse consultant with over a decade of experience in anaesthesia, sedation and pain management.

This involves patient care, as well as lecturing at post grad level on these topics, presenting at conferences and co-developing a very successful sedation course at SedateUK. My passion for creating safer environments for patients and professionals led me to collaborate with Medtronic and share my knowledge and expertise with our professional community.



The content of this article is written by a blogger with whom Medtronic has a relationship. However, the contents represent the personal objective views, comments and techniques of the blogger and are not statements from Medtronic. To the extent this material might contain images of patients or any material where a copyright is held by a third party, all necessary written permissions from the patient or copyright holder, as applicable, with respect to use, distribution or copying of such images or copyrighted materials has been obtained by the blogger.

  • 1. Peery AF, Crockett SD, Murphy CC, et al. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2021. Gastroenterology. 2022;162(2):621-644. doi:10.1053/j.gastro.2021.10.017

  • 2. National Healthcare Service (NHS). 2019. Welcome to Endoscopy. Available at:

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  • 7. ASGE Ensuring Safety in the Gastrointestinal Endoscopy Unit Task Force; Calderwood AH, Chapman FJ, Cohen J, …Early DS. 2014. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointest Endosc. 79(3):363-72. doi: 10.1016/j.gie.2013.12.015. 

  • 8. Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. 2013. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013 Jan 28;19(4):463-81. doi: 10.3748/wjg.v19.i4.463.

  • 9. ASGE Standards of Practice Committee; Early DS, Lightdale JR … DeWitt JM. 2018. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 87(2):327-337. doi: 10.1016/j.gie.2017.07.018.

  • 10. Academy of Medical Royal Colleges. 2013. Safe Sedation Practice for Healthcare Procedures Standards and Guidance. Available at: