No abstract

Patient-controlled sedation (PCS) has been explored as a sedation method in endoscopic retrograde cholangiopancreatography (ERCP), yet a comprehensive review article on this topic is lacking. We performed a systematic review to compare PCS against clinician-administered sedation. The primary objectives are to compare the sedative dosage used and the sedation depth, while secondary objectives are to compare sedation failure rates, clinician intervention rates, and patient satisfaction. A systematic literature search was conducted on MEDLINE, EMBASE, and the Cochrane Library Database using the terms “ERCP,” “Sedation,” “Patient-controlled,” and related terms. Randomized controlled trials comparing PCS against clinician-administered sedation in adults undergoing ERCP were included. Articles without English full texts were excluded. Studies were reviewed by 2 independent reviewers. The Cochrane Risk of Bias tool was used for quality assessment of individual included trials. This systematic review is registered in the International Prospective Register of Systematic Reviews (CRD42020198647). A total of 2619 articles were identified from the literature search. A total of 2615 articles were excluded based on the exclusion criteria. Four articles (comprised of 4 independent trials involving 425 patients) were included in analysis. When compared with clinician-administered sedation, PCS in ERCP may lead to lower propofol dosage used and lower sedation depth. The sedation failure rates appear to be higher in PCS, whereas lower rates of airway maneuvers are required. No significant difference was observable for patient satisfaction rates between PCS and clinician-administered sedation. The included studies demonstrated unclear to high risk of bias, particularly in randomization, incomplete outcome data, and outcome measurement. PCS appears to be a feasible option for sedation in ERCP. Nonetheless, large-scale, high-quality trials will be required before PCS can be regularly implemented in ERCP.

Endoscopic submucosal dissection (ESD) is an ad vanced endoscopic procedure for treating earlystage gastrointestinal tumours [1]. It enables en-bloc resection of lesions with organ preservation and is associated with better outcomes than other endoscopic resection procedures [2]. ESD requires extensive instrumentation in the gastrointestinal tract, and potential adverse outcomes of gastrointestinal bleeding and perforation have been reported [3,4]. ESD is generally performed under sedation [5,6]. However, the use of general anaesthesia (GA) in ESD has also been proposed [7]. GA, when compared with sedation, can minimise inadvertent patient movement [8], which may subsequently improve procedural success rates and reduce complications. We performed a systematic review and meta-analysis to compare GA versus sedation in ESD. The primary objectives of this meta-analysis were to compare the en-bloc resection rates and procedural times when comparing GA against sedation in ESD.

A bdominal pain is a cardinal feature of acute pancreatitis (AP), and thoracic epidural analgesia (TEA) has been studied as an advanced analgesic strategy in AP. 1 Aside from analgesia, TEA has secondary effects of sympathetic blockade, which may lead to splanchnic vasodilation and improvement of pancreatic microcirculation. 2 Thoracic epidural analgesia has hence been evaluated as a disease-modifying therapy for AP in clinical studies. 3,4 We performed a systematic review to assess the safety of TEA and its impact on clinical outcomes in AP. MATERIALS AND METHODSThis systematic review was performed in accordance to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO (CRD42021281548). A literature search was performed on MEDLINE, Embase, and the Cochrane Li-brary from inception until September 15, 2021, with the MeSH terms and synonyms of (1) "epidural analgesia" and (2) "acute pancreatitis." Original studies on TEA in AP patients were included, with no limit on publication date. The articles were independently screened by 2 reviewers for inclusion and data extraction.Risk of bias and level of evidence were assessed with the Cochrane Risk of Bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation system, respectively.