Gastrointestinal endoscopy under sedation is associated with pneumonia in older inpatients—results of a retrospective case-control study

Abstract

Background and aims: Apparent aspiration is a notable adverse event during gastrointestinal endoscopy under sedation (GIES), but data about inapparent aspiration are scarce. Generally, particularly older patients are at higher risk of suffering from adverse events. Objective: The objective of this article is to determine the risk of pneumonia, lower respiratory tract infection (LRI) and systemic inflammatory activation after GIES, especially in patients of at least 65 years. Methods: The retrospective case-control study included 250 patients undergoing GIES and assigned age-, gender-and time of performance-matched controls without invasive procedure or sedation (ratio 1:1). Results: On day 3 patients of advanced age presented with both pneumonia and LRI more often (2.6 vs. 0.0%, p ¼ 0.041 and 7.8 vs. 2.5%, p ¼ 0.034, respectively). In general, several inflammatory parameters increased significantly after GIES (i.e. white blood cell count (increase of ! 25%) 18.6 vs. 6.9%, p < 0.001), leading to more frequent antibiotic treatment (6.8 vs. 1.6%, p ¼ 0.004). The effects were less pronounced on day 7. Conclusions: Patients of advanced age carry an increased risk of pneumonia and LRI after GIES. Patients are generally more likely to feature inflammation and to receive antibiotic treatment.

Comparison of Lidocaine Spray and Lidocaine Ice Popsicle in Patients Undergoing Unsedated Esophagogastroduodenoscopy: A Single Center Prospective Randomized Controlled Trial

“…Oxygen supplementation was given to the underlying disease patient when required. A total of four patients experienced oxygen desaturation during the EGD; two were aged 73 and 76, and two were obese by BMI 34.69 and 37.20, consistent with the published literature [14][15][16] and our previous experience. Oxygen was administered via nasal cannula and the patients put in the left lateral position with satisfactory resolution.…”

“…[10][11][12][13] EGD under topical pharyngeal anesthesia has the advantage of avoiding unwanted cardiopulmonary adverse events from intravenous sedationlike respiratory depression, cardiorespiratory arrest, especially in patients with cardiopulmonary disease, the elderly, and obese. [14][15][16] In Thailand, lidocaine spray is commonly used and is safe and easy in procedures requiring unsedated EGD. Many studies have compared topical anesthetic agents to other formulations and techniques such as viscous, lozenge, lollipop, and nebulized lidocaine administration.…”

Endoscopic removal of common bile duct stones in nonagenarians: a tertiary centre experience

“…The increased prevalence of post-ERCP pneumonia in the elderly has been studied previously, with findings similar to our nonagenarians. 30,31 Kollman et al 31 assessed and compared factors associated with post-endoscopy pneumonia in patients >65 years old and a younger group and found older age was the most significant factor associated with pneumonia. Friedrich et al 30 reported an increased risk in those with a history of intraprocedural cough and vomiting.…”

Aktualisierte S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

“…Adipositas (BMI über 30 kg/m 2 ) ist ein Risikofaktor für eine Hypoxämie und höheres Lebensalter für eine Hypotonie unter Sedierung, wobei exakte Grenzwerte nicht definiert sind [24][25][26][27][28].…”