Which should go first during same-day bidirectional endosocopy with propofol sedation?

Area of Science:

• Gastroenterology
• Endoscopy
• Sedation Management

Background:

• Same-day bidirectional endoscopy (EGD and colonoscopy) is common for cancer screening and diagnosing GI bleeding.
• The optimal procedural sequence remains undetermined, impacting patient experience and resource utilization.

Purpose of the Study:

• To determine the optimal sequence for performing esophagogastroduodenoscopy (EGD) and colonoscopy on the same day.
• To compare patient tolerance, propofol requirements, and procedural outcomes between different sequences.

Main Methods:

• A randomized controlled trial involving 176 patients undergoing same-day EGD and colonoscopy under propofol sedation.
• Patients were assigned to either a colonoscopy-first or EGD-first group.
• Key outcomes included propofol dose, procedure duration, patient tolerance (visual analog scale), recovery time, and adverse events.

Main Results:

• No significant differences were observed in total procedure times, patient recovery, or adverse events between the groups.
• The colonoscopy-first group required a significantly higher total propofol dose (mean 135.7 mg vs. 124.7 mg).
• Patients in the colonoscopy-first group exhibited significantly more movement during the colonoscopy procedure (1.1 vs. 0.6 scores).

Conclusions:

• The recommended sequence for same-day bidirectional endoscopy is esophagogastroduodenoscopy (EGD) followed by colonoscopy.
• This EGD-first sequence leads to better patient tolerance and a lower overall propofol requirement.
• Optimizing procedural order enhances patient comfort and sedation efficiency in diagnostic endoscopy.