Randomized trial comparing general anesthesia with anesthesiologist-administered deep sedation for ERCP in...

Area of Science:

• Gastroenterology
• Anesthesiology

Background:

• Endoscopic Retrograde Cholangiopancreatography (ERCP) increasingly utilizes general anesthesia (GA) or monitored anesthesia care (MAC).
• The optimal choice between GA and MAC for ERCP remains undetermined.
• This study addresses the comparison of outcomes between GA and MAC in ERCP for patients at average risk for sedation-related adverse events (SRAEs).

Purpose of the Study:

• To compare the safety and efficacy of general anesthesia (GA) versus monitored anesthesia care (MAC) during ERCP procedures.
• To evaluate sedation-related adverse events (SRAEs), procedural outcomes, and patient and endoscopist satisfaction.
• To determine the preferred anesthetic approach for ERCP in patients with American Society of Anesthesiologists (ASA) class ≤III.

Main Methods:

• A randomized controlled trial was conducted at a tertiary referral center.
• Patients with ASA class ≤III were randomly assigned to undergo ERCP with either MAC or GA.
• The primary outcome was a composite of SRAEs, including hypotension, arrhythmia, hypoxia, hypercapnia, apnea, and procedural interruption.

Main Results:

• Sedation-related adverse events (SRAEs) occurred significantly less frequently in the general anesthesia (GA) group (9%) compared to the monitored anesthesia care (MAC) group (35%) (P < .001).
• While GA induction time was longer, there were no significant differences in ERCP procedure time, success rates, or adverse events between GA and MAC.
• General anesthesia (GA) led to significantly higher endoscopist and patient satisfaction scores compared to monitored anesthesia care (MAC) (P < .001).

Conclusions:

• General anesthesia (GA) is a safe and effective option for ERCP in patients with ASA scores ≤III, associated with fewer SRAEs than MAC.
• GA does not negatively impact ERCP procedural success or increase adverse events, despite a longer induction time.
• The enhanced patient and endoscopist satisfaction observed with GA supports its consideration for ERCP procedures in this patient population.