Which should go first during same‐day bidirectional endosocopy with propofol sedation?

Hsieh, Yu Hsi; Lin, Hwai Jeng; Tseng, Kuo‐Chih

doi:10.1111/j.1440-1746.2011.06786.x

Cited by 19 publications

(52 citation statements)

References 30 publications

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“…Internationally, sedation for colonoscopy varied widely and nearly 30% colonoscopic procedure received deep sedation [31]. In Taiwan, most of patients and endoscopists favored deep sedation for the endoscopic procedures despite greater use of resource, monitoring and anesthetist [12,13]. Further worldwide observation is warranted.…”

Section: Discussionmentioning

confidence: 99%

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Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

Yen

Lan

et al. 2012

BMC Gastroenterol

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BackgroundThere is increasing interest in balanced propofol sedation (BPS) titrated to moderate sedation (conscious sedation) for endoscopic procedures. However, few controlled studies on BPS targeted to deep sedation for diagnostic endoscopy were found. Alfentanil, a rapid and short-acting synthetic analog of fentanyl, appears to offer clinically significant advantages over fentanyl during outpatient anesthesia.It is reasonable to hypothesize that low dose of alfentanil used in BPS might also result in more rapid recovery as compared with fentanyl.MethodsA prospective, randomized and double-blinded clinical trial of alfentanil, midazolam and propofol versus fentanyl, midazolam and propofol in 272 outpatients undergoing diagnostic esophagogastroduodenal endoscopy (EGD) and colonoscopy for health examination were enrolled. Randomization was achieved by using the computer-generated random sequence. Each combination regimen was titrated to deep sedation. The recovery time, patient satisfaction, safety and the efficacy and cost benefit between groups were compared.Results260 participants were analyzed, 129 in alfentanil group and 131 in fentanyl group. There is no significant difference in sex, age, body weight, BMI and ASA distribution between two groups. Also, there is no significant difference in recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between two groups. Though deep sedation was targeted, all cardiopulmonary complications were minor and transient (10.8%, 28/260). No serious adverse events including the use of flumazenil, assisted ventilation, permanent injury or death, and temporary or permanent interruption of procedure were found in both groups. However, fentanyl is New Taiwan Dollar (NT$) 103 (approximate US$ 4) cheaper than alfentanil, leading to a significant difference in total cost between two groups.ConclusionsThis randomized, double-blinded clinical trial showed that there is no significant difference in the recovery time, satisfaction score from patients, propofol consumption, awake time from sedation, and sedation-related cardiopulmonary complications between the two most common sedation regimens for EGD and colonoscopy in our hospital. However, fentanyl is NT$103 (US$ 4) cheaper than alfentanil in each case.Trial registrationInstitutional Review Board of Buddhist Tzu Chi General Hospital (IRB097-18) and Chinese Clinical Trial Registry (ChiCTR-TRC-12002575)

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Section: Discussionmentioning

confidence: 99%

“…In addition, deep sedation rather than moderate sedation for endoscopy was preferred by most of the patients undergoing diagnostic colonoscopy for health check-up in Taiwan [12,13]. …”

Section: Introductionmentioning

confidence: 99%

Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

Yen

Lan

et al. 2012

BMC Gastroenterol

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“…A recent US study based on a national endoscopic database showed that over 11 % of subjects had received same-day bidirectional endoscopy [2]. Of the procedures, EGD is usually performed before colonoscopy due to its superior tolerability and the lower dose of sedatives needed [3]. Now, we have another reason to perform EGD before colonoscopy-to deliver the bowel preparation regimen.…”

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confidence: 99%

Bowel Preparation: Is Endoscopic Administration Worth the Extra Risk?

Hsieh

Koo

2014

Dig Dis Sci

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Bowel preparation before colonoscopy is usually considered worse than the actual procedure. The regimen usually consists of the intake of a large amount of fluid (2-4 L) with an unpalatable taste and smell, which might lead to nausea, vomiting, bloating, and abdominal pain in addition to the required diarrhea. In a meta-analysis comparing the effectiveness of different bowel preparation agents, about 29 % of the subjects were unable to ingest the full volume of polyethylene glycol (PEG) solution [1]. Incomplete consumption of the solution usually affects the quality of bowel cleansing, increasing the probability that the procedure will be aborted and then repeated.One of the conventional ways to overcome the barrier of ingesting a large amount of an unpalatable solution is to instill it directly into the stomach with the use of a nasogastric (NG) tube. Nevertheless, shortcomings including subjects' discomfort, nasopharyngeal trauma, tube misplacement, and pulmonary aspiration have precluded its general use. It is now used only for subjects with dysphagia or with difficulty of ingesting large volume of fluids.Delivering cathartic solutions such as PEG via an esophagogastroduodenoscope into the duodenum is a novel approach to bowel preparation. Although it is impractical to perform esophagogastroduodenoscopy (EGD) just for the sake of infusing bowel preparation regimen, same-day EGD and colonoscopy (bidirectional endoscopy) are commonly performed for the evaluation of gastrointestinal conditions, such as active gastrointestinal bleeding, iron deficiency anemia, positive fecal occult blood test, and abdominal pain. In addition to these indications, asymptomatic subjects undergo bidirectional endoscopy in the course of routine healthcare evaluation or for cancer screening. A recent US study based on a national endoscopic database showed that over 11 % of subjects had received same-day bidirectional endoscopy [2]. Of the procedures, EGD is usually performed before colonoscopy due to its superior tolerability and the lower dose of sedatives needed [3]. Now, we have another reason to perform EGD before colonoscopy-to deliver the bowel preparation regimen.

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“…Hsieh et al . reported that lower propofol doses were needed when a same‐day BDE procedure started with the EGD (124.7 vs 135.7 mg for EGD‐colonoscopy and colonoscopy‐EGD groups, respectively, P = 0.024) . However, in another same‐day BDE study using moderate sedation with meperidine and midazolam, Carter et al .…”

Section: Discussionmentioning

confidence: 96%

“…Two studies showed that EGD was perceived to be more stressful to patients when preceded by colonoscopy in unsedated patients . Three other studies, using moderate or deep sedation for BDE, showed that EGD followed by colonoscopy was superior in terms of better EGD tolerability and lower sedative dosages . However, a recent study with moderate sedation found that there was no difference in patient discomfort and satisfaction regarding the procedure sequence .…”

Section: Introductionmentioning

confidence: 99%

Optimal procedural sequence for same‐day bidirectional endoscopy with moderate sedation: A prospective randomized study

Chen

Cheng

Liu

et al. 2018

J of Gastro and Hepatol

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Which should go first during same‐day bidirectional endosocopy with propofol sedation?

Abstract: The optimal sequence for same-day bidirectional endoscopy is EGD followed by colonoscopy. In this order, the procedure is better tolerated, and patients require a lower overall dose of propofol.

Cited by 19 publications

References 30 publications

Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study

Bowel Preparation: Is Endoscopic Administration Worth the Extra Risk?

Optimal procedural sequence for same‐day bidirectional endoscopy with moderate sedation: A prospective randomized study

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