Optimal sequences of same-visit bidirectional endoscopy: Systematic review and meta-analysis

Area of Science:

• Gastroenterology
• Endoscopy
• Clinical Research

Background:

• Same-visit colonoscopy and esophagogastroduodenoscopy (EGD) are increasingly common procedures.
• Conflicting evidence exists regarding the optimal sequence for combined EGD and colonoscopy.

Purpose of the Study:

• To compare the performance, safety, and patient discomfort between EGD followed by colonoscopy (E-C) and colonoscopy followed by EGD (C-E).

Main Methods:

• A meta-analysis of six randomized controlled trials was conducted.
• Outcomes assessed included procedural performance (cecal intubation time, adenoma/polyp detection rates), patient and endoscopist discomfort scores, and sedation use.

Main Results:

• The E-C sequence demonstrated significantly lower use of fentanyl and propofol compared to the C-E sequence.
• Patients and endoscopists reported significantly lower discomfort scores in the E-C group.
• No significant differences were observed in cecal intubation time, adenoma detection rate, or polyp detection rate between the two sequences.

Conclusions:

• The E-C sequence is associated with reduced sedation requirements and improved patient and endoscopist comfort.
• The E-C sequence is recommended as the optimal order for combined EGD and colonoscopy due to better patient experience without compromising diagnostic yield.