Comparison of three sedation models for same‐day painless bidirectional endoscopy: A multicenter randomized controlled trial

Abstract

Background and Aim We investigated the most beneficial propofol sedation model for same‐day painless bidirectional endoscopy (BDE). Methods Asymptomatic participants scheduled for same‐day painless BDE examination from October 2020 to September 2021 were randomized to three groups: sedated esophagogastroduodenoscopy followed by unsedated colonoscopy (Group A); sedated esophagogastroduodenoscopy followed by sedated colonoscopy (Group B); and sedated esophagogastroduodenoscopy followed by sedated insertion colonoscopy (Group C). Patient discomfort, colonoscopy performance, doses of propofol, cardiovascular stress, anesthesia resuscitation, and sedation‐related adverse events were evaluated. Results A total of 3200 participants were analyzed. Baseline demographics, patient discomfort, cecal intubation rate, adenoma detection rate and sedation‐related adverse events were similar in the three groups. Propofol dose was the lowest in Group A (137.65 ± 36.865 mg) compared with Group B (177.71 ± 40.112 mg, P < 0.05) and Group C (161.63 ± 31.789 mg, P < 0.05). Decline in vital signs was most obvious in Group B during the procedure (P < 0.05). Recovery time was the shortest in Group A (5.01 ± 1.404 min) compared with Group B (9.51 ± 2.870 min, P < 0.05) and Group C (5.83 ± 2.594 min, P < 0.05); discharge time was the shortest in Group A (3.53 ± 1.685 min) compared with Group B (11.29 ± 5.172 min, P < 0.05) and Group C (6.47 ± 2.338 min, P < 0.05). Adenomas per positive patient of Group A (2.29 ± 1.055) and Group C (2.28 ± 0.931) were more than that in Group B (2.11 ± 0.946, P < 0.05). Conclusions Sedated esophagogastroduodenoscopy followed by unsedated colonoscopy is the superior model for same‐day painless BDE with the benefits of satisfactory patient comfort, reduced sedation dose, less cardiovascular stress, faster recovery, shorter discharge time and high colonoscopy quality.

Pengaruh Edukasi Berbasis Theory of Comfort terhadap Kenyamanan Penderitaendoskopi Gastrointestinal: A Systematic Review

“…(Dewi Manik et al, 2022) mengidentifikasi faktor-faktor yang berhubungan dengan kecemasan penderita dalam menjalani endoskopi, terdapat hubungan yang signifikan antara tindakan endoskopi saluran cerna dengan tingkat kecemasan. Diharapkan perawat kompeten dalam memberikan asuhan keperawatan yang komprehensif untuk menurunkan tingkat kecemasan penderita dengan memberikan edukasi kepada penderita tentang prosedur tindakan endoskopi, mengajarkan penderita cara menurunkan kecemasan saat akan dilakukan tindakan, serta memberikan saran kepada keluarga agar memberikan dukungan kepada penderita (Sui et al, 2022). Terdapat hubungan antara usia, jenis kelamin dan tingkat pendidikan dengan kecemasan penderita yang menjalani endoskopi.…”

Comparison of remimazolam and propofol combined with low dose esketamine for pediatric same-day painless bidirectional endoscopy: a randomized, controlled clinical trial

“…Same-day bidirectional endoscopy (BDE), including esophagogastroduodenoscopy (EGD) and colonoscopy, is commonly administered to evaluate gastrointestinal conditions ( Sui et al, 2022 ). It has the advantages of reducing sedation times, shortening hospital stays, and reducing healthcare costs and has been increasingly applied in children, with indications including abdominal pain, vomiting, chronic diarrhoea, hematochezia, and anaemia ( Urquhart et al, 2009 ; Hsieh et al, 2011 ; Isoldi et al, 2021 ).…”

Comparison of propofol‐based sedation and midazolam sedation in pediatric bidirectional endoscopy conducted by pediatric gastroenterologists

“…The effectiveness of same‐day bidirectional endoscopy, that is, the execution of both esophagogastroduodenoscopy (EGD) and colonoscopy procedures, has been reported for adult patients. 1 , 2 , 3 The benefits of same‐day bidirectional endoscopy include a shorter hospital stay, reduced medical costs, and a reduction of the total sedation dose. Regardless of which comes first, EGD or colonoscopy, same‐day bidirectional endoscopy may also contribute to a quicker diagnosis of gastrointestinal diseases such as gastrointestinal bleeding, inflammatory bowel disease, and eosinophilic gastroenteritis, and it arguably improves the quality of health care.…”