Comparison of procedural sequences in same‐day painless bidirectional endoscopy: Single‐center, prospective, randomized study

Abstract

Background and Aim: To compare the efficacy and safety of esophagogastroduodenoscopy (EGD)-colonoscopy and colonoscopy-EGD sequences for patients subjected to same-day bidirectional endoscopy under remifentanil and propofol sedation.Methods: A total of 209 eligible outpatients scheduled for diagnostic same-day bidirectional endoscopy between 16 February 2016 and 30 April 2016 were randomly assigned to the EGDcolonoscopy (n = 106) and colonoscopy-EGD (n = 103) sequence groups. Primary endpoint was total dose of propofol required for the procedure. Secondary endpoints included duration of endoscopy, patient satisfaction, adverse effects, endoscopy findings, and cardiopulmonary responses of the patients.Results: Patients in the two groups were similar in terms of demographic and clinical data (P > 0.05). EGD-colonoscopy sequence group had lesser requirement of propofol for sedation (P < 0.05), faster recovery (P < 0.001), and lesser influence on mean arterial pressure (MAP) during the endoscopy (P < 0.05). Duration of EGD and colonoscopy, patient satisfaction, adverse effects, and pathological findings did not differ between the two groups. Conclusions:The EGD-colonoscopy sequence may be considered the preferred sequence for same-day bidirectional endoscopy as a result of less cardiovascular stress, lessened need for sedation with propofol, and faster recovery.

Comparison of procedural sequence in same-day bidirectional endoscopy: a systematic review and meta-analysis

“…The studies were conducted in East Asia [3,4,6,7] and West Asia [2]. All the articles were written in English.…”

“…All the articles were written in English. A sedative was administered in four studies [2][3][4]7], of which a sedative was administered to a subset of participants in one study [3]. Sedation was performed by anesthesiologists in two studies [6,7] and, in one study, by an endoscopist and a nurse under the supervision of the endoscopist [5].…”

“…If an agreement could not be reached, the diswww.kjim.org https://doi.org/10.3904/kjim.2019.319 pute was resolved with the aid of a third investigator (H.K.). The standardized form included the following items: (1) title, (2) name of the first author, (3) name of journal, (4) year of publication, (5) country, (6) sex, (7) age, (8) institution, (9) premedication drug used, (10) sedative used, (11) number of participants, (12) sedation implementer, (13) Institutional Review Board (IRB) approval, (14) clinical trial registration, (15) primary endpoint, (16) total amount of sedative used, (17) total amount of analgesic used, (18) satisfaction score, (19) pain or discomfort score during the procedure, (20) duration of total procedure, EGD and colonoscopy, (21) cecal intubation, (22) pathology found during procedure, (23) adenoma detection rate, (24) complications including hypoxia, hypotension, bradycardia, tachycardia, and hypertension, (25) post-procedural complications including pain, abdominal fullness, nausea, dizziness, sore throat, and cough, (26) recovery time, and (27) risk of bias.…”

“…Bias arising from the randomization process was assessed as a concern in four studies [2][3][4]6] and as a low risk in two studies [5,7]. The evaluations were low risk in all studies for the other bias domains [2][3][4][5][6][7] due to deviations from intended interventions, due to missing outcome date, in the measurement of the outcome, and selection of the reported results. The assessments of risk of bias are shown in Table 2.…”

“…Carter et al [2] reported that the procedural sequence did not affect patients' discomfort and satisfaction, and Choi et al [3] presented that there was no significant difference in the colonoscopy performance and quality between upper and lower gastrointestinal endoscopy in same-day BDE. Conversely, some researchers demonstrated that for same-day BDE, EGD followed by colonoscopy was the optimal procedural sequence in terms of patients' tolerance, recovery, or required sedative dose [4][5][6][7][8]. However, an anesthesiologist's viewpoint suggested that colonoscopy followed by EGD was preferable [9] and asserted that when BDE is performed under deep sedation, EGD preceded by colonoscopy was more tolerable because the latter is usually performed under a deeper level of sedation [9].…”