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

Shuo Wei Chen, Chi Liang Cheng, Nai Jen Liu, Jui-Hsiang Tang, Yen Lin Kuo, Cheng Hui Lin, Yi Ning Tsui, Bai Ping Lee, Hsiang Ling Hung

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5 Citations (Scopus)

Abstract

Background and Aim: Same-day bidirectional endoscopy (BDE) is a commonly performed procedure, but the optimal sequence for the procedure with moderate conscious sedation is not well established. This study investigated the optimal sequence for same-day BDE under moderate conscious sedation and carbon dioxide insufflation in terms of sedation doses, patient discomfort, and colonoscopy performance. Methods: A prospective randomized controlled study of 120 patients who were scheduled for BDE examination was performed. Colonoscopy followed by esophagogastroduodenoscopy (EGD) examination was performed in 60 patients (colonoscopy-EGD group), and EGD followed by colonoscopy examination was performed in another 60 patients (EGD-colonoscopy group). Endoscopists and patients completed a questionnaire to assess objective and subjective discomfort. Results: Baseline demographics, procedure indications, bowel preparation quality, cecal intubation rate/time, colonoscopy withdrawal time, endoscopic interventions, BDE procedure time, colon polyp/adenoma detection rates, patient discomfort, and adverse events were similar between the two study groups. The total doses of fentanyl and midazolam were significantly higher for the colonoscopy-EGD group than for the EGD-colonoscopy group (83.4 ± 17.7 vs 68.7 ± 18.6 μg and 6.3 ± 1.4 vs 5.2 ± 1.3 mg, P < 0.0001 and P < 0.0001, respectively). The recovery time to discharge was significantly longer for the colonoscopy-EGD group than for the EGD-colonoscopy group (43.5 ± 16.2 vs 34.5 ± 8.9 min, P = 0.0003). Conclusions: 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.

Original languageEnglish
Pages (from-to)689-695
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume33
Issue number3
DOIs
Publication statusPublished - Mar 1 2018

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Keywords

  • bidirectional endoscopy
  • carbon dioxide
  • colonoscopy
  • esophagogastroduodenoscopy
  • moderate sedation
  • Prospective Studies
  • Humans
  • Middle Aged
  • Fentanyl
  • Male
  • Carbon Dioxide
  • Anesthesia, Inhalation/methods
  • Conscious Sedation/methods
  • Colonoscopy
  • Ambulatory Surgical Procedures
  • Anesthesia Recovery Period
  • Adult
  • Female
  • Surveys and Questionnaires
  • Midazolam
  • Endoscopy, Digestive System

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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