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

Abstract

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.

Propofol Sedation in Pediatric Upper Endoscopy: A Study of Pharmacodynamics and the Effects of Gastroenterologists, Anesthesiologists, and Supervised Participants on the Procedure Time and Sedation Time

“…Even though the correlation to the procedure time and sedation time is not dramatically different between the different propofol dosing, the BMI and BSA should be considered as methods of calculating propofol dose, especially in dosing underweight and overweight children, where per kg dosing may be less ideal. Interestingly, one adult study that used propofol found that the UE time was 0.21 minutes longer for every additional BMI unit, which was similar to our study's 0.34 minutes, suggesting that the BMI can potentially be used as a predictor of procedure time [13]. This must be investigated further in prospective studies to consider the viability of creating a standardized dosing regimen for propofol with fentanyl based on BMI or BSA for pediatric UEs, focusing on the safety of that sedation regime.…”

Clinical effectiveness of bidirectional fecal microbiota transfer in the treatment of recurrent Clostridioides difficile infections

“…While capsule FMT may be considered the safest procedure, our analysis shows a substantially higher primary response to bFMT when compared to treatment with oral capsules [15] . In clinical practice, local availability of these approaches and patient preference will be crucial determinants in the choice of route of application.…”