Comparison of procedural sequences in same-day painless bidirectional endoscopy: Single-center, prospective,...

Area of Science:

• Gastroenterology
• Endoscopy
• Sedation Pharmacology

Background:

• Same-day bidirectional endoscopy involves both esophagogastroduodenoscopy (EGD) and colonoscopy.
• Sedation, typically with propofol and remifentanil, is used for these procedures.
• The sequence of EGD and colonoscopy may impact procedural outcomes and patient experience.

Purpose of the Study:

• To compare the efficacy and safety of EGD-colonoscopy versus colonoscopy-EGD sequences.
• To evaluate sedation requirements, recovery time, and patient satisfaction.
• To assess cardiovascular and respiratory responses during same-day bidirectional endoscopy.

Main Methods:

• 209 outpatients undergoing same-day bidirectional endoscopy were randomized into EGD-colonoscopy or colonoscopy-EGD groups.
• Propofol dose was the primary endpoint; secondary endpoints included procedure duration, patient satisfaction, adverse events, and cardiopulmonary parameters.
• Procedures were performed under remifentanil and propofol sedation.

Main Results:

• The EGD-colonoscopy group required significantly less propofol for sedation.
• Patients in the EGD-colonoscopy group experienced faster recovery and less impact on mean arterial pressure.
• No significant differences were observed in procedure duration, patient satisfaction, or adverse/pathological findings between the groups.

Conclusions:

• The EGD-colonoscopy sequence is preferable for same-day bidirectional endoscopy.
• This sequence leads to reduced propofol sedation, less cardiovascular stress, and quicker patient recovery.
• The findings support optimizing procedural sequencing for improved patient outcomes in combined endoscopic procedures.