Optimal Sequencing in Same-Day Bidirectional Endoscopy: A Tertiary US Healthcare Center Experience

Area of Science:

• Gastroenterology
• Endoscopy
• Clinical Research

Background:

• Bidirectional endoscopy (BDE), involving same-day esophagogastroduodenoscopy (EGD) and colonoscopy, is common but lacks an established optimal procedural sequence.
• This study investigates the optimal sequence for BDE in the US.

Purpose of the Study:

• To determine the optimal sequence for performing EGD and colonoscopy during same-day bidirectional endoscopy (BDE).
• To compare procedure duration, sedation requirements, diagnostic yield, and extent reached between EGD-first (UL) and colonoscopy-first (LU) sequences.

Main Methods:

• A retrospective cohort study of 16,538 patients undergoing same-day BDE between 2003 and 2018.
• Patients were divided into two groups: EGD followed by colonoscopy (UL) and colonoscopy followed by EGD (LU).
• Endpoints analyzed included procedure duration, sedation use, diagnostic yield (polyp and adenoma detection rates), and extent reached.

Main Results:

• The EGD-first (UL) sequence was associated with significantly shorter total procedure durations (23.2 vs. 28.8 min) and shorter durations for both EGD (5.4 vs. 6.5 min) and colonoscopy (17.9 vs. 22.3 min).
• Patients in the colonoscopy-first (LU) group were more likely to require opioids (OR 2.8), benzodiazepines (OR 3.0), and antihistamines, but less likely to require anesthesia (OR 0.33).
• Both UL and LU sequences demonstrated comparable polyp detection rates (37.6% vs. 38.1%) and adenoma detection rates (ADR).

Conclusions:

• Performing EGD before colonoscopy in BDE leads to shorter procedure times.
• The EGD-first sequence reduces the likelihood of requiring opioids and benzodiazepines.
• There were no significant differences in diagnostic yield or procedure-related adverse events between the two sequences.