Gastrointestinal and non-gastrointestinal complication rates associated with diagnostic esophagogastroduodenoscopy under sedation

Abstract

Esophagogastroduodenoscopy (EGD) under sedation may result in gastrointestinal (GI) and non-GI complications. However, no previous studies have reported 30-day GI and non-GI complications after diagnostic EGD under sedation.We conducted a retrospective, observational study of 30-day GI and non-GI complication rates after outpatient diagnostic EGD under sedation in subjects ≥18 years between January 2012 and December 2017 based on a common data model database. Thirty-day complication rates were compared with EGD under sedation or not, type of sedation drugs (midazolam only vs midazolam/propofol) and age groups (18-64 year vs ≥65 year) for GI (bleeding and perforation) and non-GI complications (pneumonia, acute myocardial infarction, congestive heart failure and cerebral stroke).In total, 39,910 were performed with sedation (midazolam only, n = 16,033 and midazolam/propofol, n = 23,864) and 22,894 were performed without sedation. Elderly patients significantly favored EGD without sedation (P < .01). GI and non-GI complication rates were similar between EGD under sedation and without sedation (all P > .1) except for acute myocardial infarction rate, which was significantly higher in EGD without sedation than EGD under sedation (1.7/10,000 vs 0.3/10,000 persons, P = .043). All GI and non-GI complications were also similar between the midazolam/propofol and midazolam only groups as well as between young and old patients (all P > .1).Outpatient diagnostic EGD under sedation has an excellent safety profile. In addition, it can be safely performed with midazolam only or midazolam/propofol and in young and old patients.

Up-to-date literature review and issues of sedation during digestive endoscopy.

“…conducting sedation by a non-anaesthesiologist) should only be done with optimal characteristics of the sedative, like minimal associated risks and low profile of adverse events, short recovery time, potent anxiolytic/analgesic effects, and a predictable pharmacokinetic profile. It should be noted that some studies also validated the safety of practicing sedation by non-anaesthesiologists with drugs like propofol [ 15 , 147 ]. Further studies also demonstrated the safety and efficacy of propofol-related sedation conducted by physicians and trained nurses for upper gastrointestinal endoscopic procedures [ 127 , 148 – 150 ].…”

“…An increased risk of developing these complications is observed among patients with comorbidities, and the incidence does not usually differ between non-anaesthetist and anaesthetist clinicians. Various complications have been reported, mainly bronchopulmonary aspiration, vasovagal events, arrhythmia, hypotension, and hypoxaemia [13][14][15][16]. Among the different complications, estimates indicate that cardiopulmonary complications are the most serious and common.…”

The Impact of Sedation on Cardio-Cerebrovascular Adverse Events after Surveillance Esophagogastroduodenoscopy in Patients with Gastric Cancer: A Nationwide Population-Based Cohort Study

“…Although surveillance EGD is generally regarded as safe, EGD itself or the use of sedative agents during EGD has some potential to cause adverse events. 8 - 10 Particularly, cardio-cerebrovascular (CCV) adverse events following EGD may be responsible for a majority of the mortality. In a nationwide survey study in the United States, the risk of cardiac adverse events was one of the main considerations for clinicians in deciding whether to use sedative agents during EGD.…”

“… 11 Several studies have reported CCV adverse events following diagnostic EGD in the average-risk population. 8 , 9 , 12 , 13 However, data on CCV adverse events following surveillance EGD in patients with GC have not been reported. Therefore, we aimed to investigate the incidence of CCV adverse events, including cardiac and cerebral adverse events, arterial thromboembolism (ATE), and pulmonary embolism (PE), after surveillance EGD with or without sedation in patients with GC.…”