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

Research output: Contribution to journalArticle

3 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

Fingerprint

Conscious Sedation
Digestive System Endoscopy
Colonoscopy
Endoscopy
Prospective Studies
Insufflation
Carbon Dioxide
Midazolam
Fentanyl
Polyps
Intubation
Adenoma
Colon

Keywords

  • bidirectional endoscopy
  • carbon dioxide
  • colonoscopy
  • esophagogastroduodenoscopy
  • moderate sedation

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Optimal procedural sequence for same-day bidirectional endoscopy with moderate sedation : A prospective randomized study. / Chen, Shuo Wei; Cheng, Chi Liang; Liu, Nai Jen; Tang, Jui-Hsiang; Kuo, Yen Lin; Lin, Cheng Hui; Tsui, Yi Ning; Lee, Bai Ping; Hung, Hsiang Ling.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 33, No. 3, 01.03.2018, p. 689-695.

Research output: Contribution to journalArticle

Chen, Shuo Wei ; Cheng, Chi Liang ; Liu, Nai Jen ; Tang, Jui-Hsiang ; Kuo, Yen Lin ; Lin, Cheng Hui ; Tsui, Yi Ning ; Lee, Bai Ping ; Hung, Hsiang Ling. / Optimal procedural sequence for same-day bidirectional endoscopy with moderate sedation : A prospective randomized study. In: Journal of Gastroenterology and Hepatology (Australia). 2018 ; Vol. 33, No. 3. pp. 689-695.
@article{0bab84b0c0044cf7b012c97a488a14e5,
title = "Optimal procedural sequence for same-day bidirectional endoscopy with moderate sedation: A prospective randomized study",
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.",
keywords = "bidirectional endoscopy, carbon dioxide, colonoscopy, esophagogastroduodenoscopy, moderate sedation",
author = "Chen, {Shuo Wei} and Cheng, {Chi Liang} and Liu, {Nai Jen} and Jui-Hsiang Tang and Kuo, {Yen Lin} and Lin, {Cheng Hui} and Tsui, {Yi Ning} and Lee, {Bai Ping} and Hung, {Hsiang Ling}",
year = "2018",
month = "3",
day = "1",
doi = "10.1111/jgh.13971",
language = "English",
volume = "33",
pages = "689--695",
journal = "Journal of Gastroenterology and Hepatology (Australia)",
issn = "0815-9319",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Optimal procedural sequence for same-day bidirectional endoscopy with moderate sedation

T2 - A prospective randomized study

AU - Chen, Shuo Wei

AU - Cheng, Chi Liang

AU - Liu, Nai Jen

AU - Tang, Jui-Hsiang

AU - Kuo, Yen Lin

AU - Lin, Cheng Hui

AU - Tsui, Yi Ning

AU - Lee, Bai Ping

AU - Hung, Hsiang Ling

PY - 2018/3/1

Y1 - 2018/3/1

N2 - 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.

AB - 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.

KW - bidirectional endoscopy

KW - carbon dioxide

KW - colonoscopy

KW - esophagogastroduodenoscopy

KW - moderate sedation

UR - http://www.scopus.com/inward/record.url?scp=85042286574&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042286574&partnerID=8YFLogxK

U2 - 10.1111/jgh.13971

DO - 10.1111/jgh.13971

M3 - Article

C2 - 28872700

AN - SCOPUS:85042286574

VL - 33

SP - 689

EP - 695

JO - Journal of Gastroenterology and Hepatology (Australia)

JF - Journal of Gastroenterology and Hepatology (Australia)

SN - 0815-9319

IS - 3

ER -