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

Chen, Shuo Wei; Cheng, Ching‐Yi; Liu, Nai Jen; Tang, Jui Hsiang; Kuo, Yen Lin; Lin, Cheng Hui; Tsui, Yi Ning; Lee, Bai Ping; Hung, Hsiang Ling

doi:10.1111/jgh.13971

Cited by 13 publications

(29 citation statements)

References 31 publications

(63 reference statements)

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“…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]. The study characteristics are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Risk Of Biasmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Choi

Seong

et al. 2020

Korean J Intern Med

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Background/Aims: To compare the efficacy and safety of procedural sequence in same-day bidirectional endoscopy. Methods: We searched OVID-MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar to identify randomized controlled trials that compared the procedural sequences in same-day bidirectional endoscopy, including esophagogastroduodenoscopy (EGD) and colonoscopy. The sedative and analgesic doses required, discomfort and satisfaction scores, procedure time, recovery time, adenoma detection rate, and failed cecal intubation were evaluated. Adverse effects, including respiratory and cardiovascular complications, were also assessed. Results: We included six studies, with 1,848 patients in total. The requirement for sedative treatment was significantly lesser in the EGD-colonoscopy sequence than in the colonoscopy-EGD sequence (standardized mean difference [SMD], -0.39; 95% confidence interval [CI], -0.54 to -0.24; p = 0.12; I 2 = 49%). Discomfort, scored by patients during the EGD procedure, was significantly lesser in the EGD-colonoscopy sequence than in the colonoscopy-EGD sequence (SMD, -0.45; 95% CI, -0.80 to -0.09; p = 0.02; I 2 = 73%), while it was comparable during colonoscopy between the two sequences. Recovery time was significantly shorter in the EGD-colonoscopy sequence than in the colonoscopy-EGD sequence (SMD, -0.47; 95% CI, -0.65 to -0.30; p = 0.28; I 2 = 21%). Total procedure duration, EGD, colonoscopy, cecal intubation time and incidence, incidences of pathologic findings, and adenoma detection were comparable between the two sequences. There was no significant difference in the incidences of desaturation, hypotension, hypertension, bradycardia, and tachycardia between the two sequences. Conclusions: When conducting same-day bidirectional endoscopy, EGD followed by colonoscopy is the most beneficial sequence to be used because patients require lower sedative doses, recover faster, and report lesser discomfort.

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Section: Resultsmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Choi

Seong

et al. 2020

Korean J Intern Med

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“…However, sedation increases the cost and 30-day complications. 29,30 Nevertheless, the current study showed that on-demand sedation was practical not only in the west but also in Taiwan. 28 In Taiwan, colonoscopy was usually performed without sedation or with minimal sedation in the past, while full sedation is rapidly gaining popularity in recent years.…”

Section: Discussionmentioning

confidence: 66%

“…28 In Taiwan, colonoscopy was usually performed without sedation or with minimal sedation in the past, while full sedation is rapidly gaining popularity in recent years. 29,30 Nevertheless, the current study showed that on-demand sedation was practical not only in the west but also in Taiwan. The addition of WE further augmented its effect on reducing the use of sedation.…”

Section: Discussionmentioning

confidence: 66%

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Hsieh

Tseng

Koo

et al. 2019

J of Gastro and Hepatol

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Background and Aim Completion of colonoscopy without sedation eliminates sedation cost and complications. Reported in the United States and Europe, on‐demand sedation is not routine practice in Taiwan. Water exchange (WE), characterized by infusion and nearly complete removal of infused water during insertion, reduces insertion pain compared to air insufflation (AI) during colonoscopy. We evaluated the feasibility of on‐demand sedation in Taiwan. In a randomized controlled trial of WE vs AI colonoscopy, we also aimed to determine if WE augmented the implementation by reducing insertion pain and decreasing sedation requirement. Methods This prospective patient‐blinded study randomized patients to AI or WE (75 patients/group) to aid insertion. The primary outcome was the proportion of patients completing without sedation. Results In the AI and WE groups, 76.0% and 93.3% (P = 0.006) completed without need for sedation, respectively. The WE group had lower insertion pain score (mean [SD]) (4.0 [2.9] vs 2.1 [2.6], P < 0.001), lower doses of propofol (25.7 [52.7] mg vs 9.1 [35.6] mg, P = 0.012), and less time in the recovery room (3.4 [7.4] vs 1.5 [5.5], P = 0.027) than the AI group. Patient satisfaction scores and willingness to repeat if needed in the future were similar. Conclusion On‐demand sedation was feasible in Taiwan. The completion rate without sedation was high in patients (76.0% with standard AI) open to the option (no prior intent to receive the standard of full or minimal sedation). WE augmented the implementation by reducing insertion pain and decreasing sedation requirement without adversely affecting patient satisfaction or willingness to repeat.

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Sequence of same‐day upper and lower gastrointestinal endoscopy does not affect total procedure' time or medication use: A randomized trial

et al. 2019

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Background and AimSame‐day double upper and lower gastrointestinal endoscopy is frequently performed due to overlapping indications. However, it is unclear whether an upper–lower (U‐L) or lower–upper (L‐U) sequence is optimal. We analyzed the effect of sequence on total procedure time and sedation use.MethodsA total of 100 patients scheduled for same‐day double endoscopy were randomized to the U‐L or L‐U sequence arm. Primary outcomes, mean total procedure time, and sedative dosages were compared using a t‐test. We also explored associations of the primary outcomes with patient‐related and procedure‐related factors.ResultsComparing U‐L and L‐U sequences, mean total procedure time was 41.9 (16.2) versus 43.0 (14.5) min (P = 0.73), diphenhydramine dose 5.5 (15.4) versus 4.5 (14.0) mg (P = 0.74), fentanyl dose 71.5 (119.3) versus 77.6 (164.02) μg (P = 0.83), midazolam dose 1.6 (2.5) versus 1.4 (2.7) mg (P = 0.69), and propofol dose 437.4 (351.4) versus 444.5 (256.0) mg (P = 0.91), respectively. Total procedure and upper endoscopy times were significantly longer with trainee presence (P = 0.0002) and shorter with conscious sedation (P = 0.003). Upper endoscopy time was longer with higher body mass index (P = 0.001), and lower endoscopy time was longer in patients with cirrhosis or chronic kidney disease (P = 0.002 and 0.009, respectively). Time between procedures was significantly longer in the L‐U sequence (7.4 [2.9] vs 5.3 [1.1] min, [P < 0.001]). The study had 80% power to detect an 8 min difference in total procedure time.ConclusionsThe sequence of same‐day double gastrointestinal endoscopy does not affect total procedure time or medication use. Longer total procedure and upper endoscopy times were associated with trainee presence and use of conscious sedation.

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

Abstract: Esophagogastroduodenoscopy followed by colonoscopy is the optimal sequence for same-day BDE under moderate conscious sedation and carbon dioxide insufflation. Following this order allows for a reduction of sedation doses and for shorter recovery times.

Cited by 13 publications

References 31 publications

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

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

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Sequence of same‐day upper and lower gastrointestinal endoscopy does not affect total procedure' time or medication use: A randomized trial

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