British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy

Abstract

Over 2.5 million gastrointestinal endoscopic procedures are carried out in the United Kingdom (UK) every year. Procedures are carried out with local anaesthetic r with sedation. Sedation is commonly used for gastrointestinal endoscopy, but the type and amount of sedation administered is influenced by the complexity and nature of the procedure and patient factors. The elective and emergency nature of endoscopy procedures and local resources also have a significant impact on the delivery of sedation. In the UK, the vast majority of sedated procedures are carried out using benzodiazepines, with or without opiates, whereas deeper sedation using propofol or general anaesthetic requires the involvement of an anaesthetic team. Patients undergoing gastrointestinal endoscopy need to have good understanding of the options for sedation, including the option for no sedation and alternatives, balancing the intended aims of the procedure and reducing the risk of complications. These guidelines were commissioned by the British Society of Gastroenterology (BSG) Endoscopy Committee with input from major stakeholders, to provide a detailed update, incorporating recent advances in sedation for gastrointestinal endoscopy.This guideline covers aspects from pre-assessment of the elective ‘well’ patient to patients with significant comorbidity requiring emergency procedures. Types of sedation are discussed, procedure and room requirements and the recovery period, providing guidance to enhance safety and minimise complications. These guidelines are intended to inform practising clinicians and all staff involved in the delivery of gastrointestinal endoscopy with an expectation that this guideline will be revised in 5-years’ time.

Patient Anxiety in Endoscopy: A Comparative Analysis of Single vs. Dual Procedure Effects

“…This observed increase in anxiety, especially with symptoms that have a physical manifestation, such as wobbliness in the legs and hot or cold sweats, highlights the profound psychosomatic response that the prospect of endoscopic procedures can evoke. It is well-documented in the literature that preoperative anxiety can adversely affect not only the patient's experience of medical procedures but also their outcomes, including increased pain perception, prolonged recovery times, and, in some cases, complications during the procedure itself [14][15][16][17].…”

Constipation and colonoscopy

“…The effect of deep sedation on the risk of colonic perforation is quite controversial[ 25 ]. In a study by Adeyemo et al [ 26 ], among a sample of 118,004 colonoscopies, it was concluded that the use of propofol was associated with an increased risk of colonic perforation.…”

Comparison of Fentanyl, Ketamine, and Lidocaine Combined with Propofol Anesthesia in Patients with Crohn Disease Undergoing Colonoscopy

“…In the context of drugs used for sedation in gastrointestinal endoscopy, the latest 2024 guidelines list drugs such as propofol, fentanyl, remimazolam, nitrous oxide, and pethidine as recommended drugs [ 8 ]. These guidelines do not reference the utilization of intravenous (i.v.)…”