Implementation of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) sedation training course in a regular endoscopy unit

Abstract

Background Several scientific societies have endorsed non-anesthesiologist sedation (NAS) during gastrointestinal endoscopy, considering it a safe procedure when administered by adequately trained personnel. This study aimed to evaluate the occurrence of adverse events after implementation of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) sedation training program. Methods From January 2017 to August 2018, data from all consecutive endoscopic procedures in adults (≥ 18 years) performed at our endoscopy unit were collected using an electronic reporting system. Results All staff (physicians and nurses) completed the ESGE-ESGENA sedation course. In total, 12 132 patients underwent endoscopic procedures, 10 755 (88.6 %) of which were performed in a non-anesthesiological setting. Of these, about 20 % used moderate sedation with midazolam + fentanyl and 80 % used deep sedation with additional propofol. No sentinel, 5 (0.05 %) moderate risk, and 18 (0.17 %) minor risk adverse events occurred, all during moderate or deep sedation, and all managed by endoscopy staff without the need for anesthesiologist assistance. Conclusions After completing the ESGE-ESGENA sedation training program, the rate of adverse events was very low in our institution. The findings support implementation of the program in all digestive endoscopy units and inclusion in the curriculum for physicians and nurses to ensure safe endoscopic procedures.

Evaluating the effect of an artificial intelligence system on the anesthesia quality control during gastrointestinal endoscopy with sedation: a randomized controlled trial

“…ENDOANGEL can prompt regarding unchecked parts, endoscopists' scope-insertion and scope-withdrawal times, which reminds anesthetists to give a supplementary dose of anesthetics at a proper time and ensures that patients stay at a moderate-sedation status. Moderate sedation can facilitate a better medical examination than deep sedation for patients and reduce adverse events [5,10]. We believe that patients are more willing to undergo sedation with ENDOANGEL assistance during endoscopic examinations based on their satisfaction scores.…”

“…However, while sedation occurs during endoscopic examinations, adverse events, such as hypotension, hypertension, arrhythmia and hypoxemia, may arise [5]. Long duration and deep sedation are independent risk factors for the appearance of adverse events, resulting in greater hospital costs [6][7][8].…”

“…Furthermore, lower skill of anesthetists and longer duration are associated with more serious adverse events, including arrhythmia, respiratory arrest and even death [7]. Therefore, it is vital to ensure appropriate sedation during endoscopic examinations [5,10].…”

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

“…Hierzu liegen neuerdings positive Empfehlungen zahlreicher internationaler Leitlinien vor [373, 381-384, 389, 390]. Auch in zumeist retrospektiven Studien konnte eine hohe Sicherheit bei der Anwendung von NAPS durch geschulte Teams dokumentiert werden [391][392][393]. Für die Sedierung mit Midazolam plus Opiaten (moderate Sedierung) konnte eine Reduktion der Zahl von Hypoxien durch trainierte, im Vergleich zu untrainierten, Endoskopikern dokumentiert werden [386]. )…”

Usefulness of discharge standards in outpatients undergoing sedative endoscopy: a propensity score-matched study of the modified post-anesthetic discharge scoring system and the modified Aldrete score

“…These benefits can also be expected to lead to earlier detection of gastrointestinal pathologies, such as cancers [3,10]. As a disadvantage, sedative endoscopy necessitates careful monitoring of a patient's vital signs and consciousness during and after the procedure [11][12][13].…”