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 journalArticlepeer-review

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 2018

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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