The burden of endoscopic retrograde cholangiopancreatography (ERCP) performed with the patient under conscious sedation

Jeurnink, Suzanne M.; Steyerberg, Ewout W.; Kuipers, Ernst J.; Siersema, Peter D.

doi:10.1007/s00464-012-2162-2

Cited by 44 publications

(32 citation statements)

References 20 publications

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“…As a result, 8% required a reversal with flumazenil and/or naloxone 35. Conversely, the inability to safely provide sufficient sedation using conscious sedation results in 40% of patients reporting pain or discomfort during ERCP 4. Intolerance of sedation contributes to more than 30% of failed ERCPs performed under conscious sedation 4 36.…”

Section: Discussionmentioning

confidence: 99%

Deep sedation and anaesthesia in complex gastrointestinal endoscopy: a joint position statement endorsed by the British Society of Gastroenterology (BSG), Joint Advisory Group (JAG) and Royal College of Anaesthetists (RCoA)

Sidhu

Turnbull

Newton

et al. 2019

Frontline Gastroenterol

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In the UK, more than 2.5 million endoscopic procedures are carried out each year. Most are performed under conscious sedation with benzodiazepines and opioids administered by the endoscopist. However, in prolonged and complex procedures, this form of sedation may provide inadequate patient comfort or result in oversedation. As a result, this may have a negative impact on procedural success and patient outcome. In addition, there have been safety concerns on the high doses of benzodiazepines and opioids used particularly in prolonged and complex procedures such as endoscopic retrograde cholangiopancreatography. Diagnostic and therapeutic endoscopy has evolved rapidly over the past 5 years with advances in technical skills and equipment allowing interventions and procedural capabilities that are moving closer to minimally invasive endoscopic surgery. It is vital that safe and appropriate sedation practices follow the inevitable expansion of this portfolio to accommodate safe and high-quality clinical outcomes. This position statement outlines the current use of sedation in the UK and highlights the role for anaesthetist-led deep sedation practice with a focus on propofol sedation although the choice of sedative or anaesthetic agent is ultimately the choice of the anaesthetist. It outlines the indication for deep sedation and anaesthesia, patient selection and assessment and procedural details. It considers the setup for a deep sedation and anaesthesia list, including the equipment required, the environment, staffing and monitoring requirements. Considerations for different endoscopic procedures in both emergency and elective setting are also detailed. The role for training, audit, compliance and future developments are discussed.

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Section: Discussionmentioning

confidence: 99%

Deep sedation and anaesthesia in complex gastrointestinal endoscopy: a joint position statement endorsed by the British Society of Gastroenterology (BSG), Joint Advisory Group (JAG) and Royal College of Anaesthetists (RCoA)

Sidhu

Turnbull

Newton

et al. 2019

Frontline Gastroenterol

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“…Conscious sedation has been reported to be inadequate for up to 14% of patients undergoing ERCP 2. Furthermore, up to half of patients undergoing ERCP under conscious sedation experience pain and discomfort during the procedure and postprocedural period 6. Data from Cochrane review showed a better recovery profile among patients receiving propofol, with a comparable safety profile with that of conscious sedation using midazolam and opioid 7.…”

Section: Discussionmentioning

confidence: 99%

Day case ‘treat and transfer’ ERCP service under general anaesthesia

El-Sherif

Hunt

Suddle

et al. 2018

Frontline Gastroenterol

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“…In patients receiving moderate sedation during ERCP, pain and discomfort during and immediately after ERCP were experienced by one third to one half of the patients due to inadequate level of sedation, as well as inadequate selection of sedative agent against type of procedure and patient physical and mental status. Incremental doses of midazolam lead to unintended deep level of sedation as well as hypotension and desaturation [4]. There was higher failure rate due to premature termination of ERCP because of inadequate sedation [5].…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine versus ketofol for moderate sedation in Endoscopic Retrograde Cholangiopancreatography (ERCP) comparative study

Hassan

2015

Egyptian Journal of Anaesthesia

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Background: Recently dexmedetomidine had been successfully used in conscious (moderate) sedation as a good competitive to popular agent (midazolam). Different concentrations of ketamine and propofol combinations (ketofol) were used for procedural sedation and analgesia. Objectives: The study was conducted to compare two techniques of moderate sedation for patients undergoing ERCP, using either dexmedetomidine or ketofol as regards hemodynamic, sedation, pain, respiratory effect, recovery time, patients' and endoscopists' satisfactions, and complications during and after the procedure. Patients and methods: Fifty patients were randomly allocated in one of two groups; dexmedetomidine group D (n = 25) received 1 lg/kg i.v. bolus over 10 min followed by 0.5 lg/kg/h or ketamine/ propofol (ketofol) group KP (n = 25) received 1 mg/kg i.v. bolus followed by 50 lg/kg/min. The level of sedation was adjusted to achieve a Ramasy sedation scale (RSS) score of 4 in both groups of patients. Mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SPO 2 ), and facial pain score (FPS) were compared. Time to achieve RSS, modified Aldrete's score (MAS) of 9-10 and the related complications were compared between groups. Patients' and endoscopists' satisfactions were compared. Total amount of rescue sedation was recorded.Results: After loading dose HR and MAP were significantly lower in group D as compared with group KP (p < 0.05). HR was significantly lower in group D during the recovery (p < 0.05). No significant difference between both groups as regards time to achieve RSS, MAS, FPS and total dose of rescue sedation. Personnel restraint was significantly lower in group KP (8% versus 20%) than in group D. Endoscopists' satisfaction was significantly higher in group KP than D group (92% and 80%) respectively. Conclusion: Ketofol (1:1) provided better hemodynamic stability than dexmedetomidine and standard alternative to it in moderate sedation during ERCP.

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The burden of endoscopic retrograde cholangiopancreatography (ERCP) performed with the patient under conscious sedation

Cited by 44 publications

References 20 publications

Deep sedation and anaesthesia in complex gastrointestinal endoscopy: a joint position statement endorsed by the British Society of Gastroenterology (BSG), Joint Advisory Group (JAG) and Royal College of Anaesthetists (RCoA)

Deep sedation and anaesthesia in complex gastrointestinal endoscopy: a joint position statement endorsed by the British Society of Gastroenterology (BSG), Joint Advisory Group (JAG) and Royal College of Anaesthetists (RCoA)

Day case ‘treat and transfer’ ERCP service under general anaesthesia

Dexmedetomidine versus ketofol for moderate sedation in Endoscopic Retrograde Cholangiopancreatography (ERCP) comparative study

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