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Comparison of three sedation models for same-day painless bidirectional endoscopy: A multicenter randomized
Journal of Gastroenterology and Hepatology
|May 26, 2022
Summary
The optimal sedation strategy for same-day painless bidirectional endoscopy (BDE) involves sedated esophagogastroduodenoscopy followed by unsedated colonoscopy. This approach enhances patient comfort, reduces propofol use, and speeds recovery and discharge times.
Area of Science:
- Gastroenterology
- Anesthesiology
- Clinical Endoscopy
Background:
- Optimizing sedation protocols for bidirectional endoscopy (BDE) is crucial for patient comfort and procedural efficiency.
- Same-day BDE offers convenience but requires careful management of sedation to ensure safety and patient satisfaction.
Purpose of the Study:
- To determine the most beneficial propofol sedation model for achieving painless, same-day bidirectional endoscopy (BDE).
- To compare patient discomfort, procedural outcomes, and safety profiles across different sedation strategies for BDE.
Main Methods:
- A randomized controlled trial involving 3200 asymptomatic participants undergoing same-day BDE.
- Participants were assigned to three groups: sedated esophagogastroduodenoscopy (EGD) followed by unsedated colonoscopy (Group A), sedated EGD followed by sedated colonoscopy (Group B), or sedated EGD followed by sedated insertion colonoscopy (Group C).
- Key outcomes included patient discomfort, colonoscopy performance metrics, propofol dosage, cardiovascular stress, and adverse events.
Main Results:
- Group A demonstrated the lowest propofol dose (137.65 mg) and shortest recovery (5.01 min) and discharge times (3.53 min) compared to Groups B and C.
- Group B showed the most significant decline in vital signs during the procedure.
- Adenoma detection rates and adverse events were similar across groups, but Groups A and C detected more adenomas per positive patient than Group B.
Conclusions:
- Sedated esophagogastroduodenoscopy followed by unsedated colonoscopy (Group A) is the superior model for same-day painless BDE.
- This strategy offers benefits including satisfactory patient comfort, reduced sedation requirements, minimized cardiovascular stress, and expedited recovery and discharge.
- The findings support the efficacy and efficiency of this specific sedation sequence for improving the BDE experience.
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