Endoscopy 2019; 51(04): S200
DOI: 10.1055/s-0039-1681764
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Clinical Endoscopic Practice ePosters
Georg Thieme Verlag KG Stuttgart · New York

WHO SHOULD ADMINISTER SEDATION DURING ERCP – ANESTHESIOLOGIST, INTENSIVIST OR ENDOSCOPIST? A COMPARATIVE PROSPECTIVE STUDY

M Alburquerque
1   Clínica Girona, Girona, Spain
,
A Vargas García
1   Clínica Girona, Girona, Spain
2   Hospital de Palamós, Palamós, Spain
,
N Zaragoza Velasco
3   Hospital Arnau de Villanova, Lleida, Spain
,
M Pechkova
1   Clínica Girona, Girona, Spain
,
J Miñana Calafat
3   Hospital Arnau de Villanova, Lleida, Spain
,
M Figa
1   Clínica Girona, Girona, Spain
,
R Ballester Clau
3   Hospital Arnau de Villanova, Lleida, Spain
,
M Planella De Robinat
4   Hospital Arnau de Villanova, Girona, Spain
,
JM Reñe Espinet
3   Hospital Arnau de Villanova, Lleida, Spain
,
F González-Húix Lladó
1   Clínica Girona, Girona, Spain
3   Hospital Arnau de Villanova, Lleida, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

To compare safety and effectiveness of sedation during ERCP (sERCP) regarding which medical doctor directs it.

Methods:

A comparative prospective non-randomized study done in daily practice. Consecutive patients who underwent to ERCP were collected at two centers. January 2017-May 2018. Sedation was directed either by an endoscopist (endoscopist-directed propofol: EDP), on Monday or by an intensivist (intensivist-administered propofol: IAP), on Wednesday or by an anesthesiologist (monitored anesthesia care: MAC), on Thursday. The safety was measured by the appearance of serious adverse events (SAE) and the effectiveness, by the cancelled ERCP rate, sedation time and patient position that determined ease of ERCP and quality of radiologic images.

Results:

454 patients (Age: 72.7 ± 15.7y; women: 54.63%): 147 into EDP group, 137, IAP group and 170, MAC group. The endoscopist had the largest experience in sERCP (> 100 procedures): 98%, p = 0.000 and he administered only propofol in 81.9%, the intensivist administered propofol plus midazolam in 78.7% and anesthesiologist, propofol plus other agents (i.e. opioids, ketamine) in 86.2%, p = 0.000. The sedation was deepest in MAC, Observers's (OAAS): 5.19 ± 0.6, p = 0.000. The SAE rate was 8.6%, lowest in EDP: 4.8%, p = 0.042. The SpO2 < 70% was the most frequent SAE: 4.5%, highest in MAC: 6.1%, p = 0.085 and it had required more respiratory resuscitation measures (chin-lift maneuver, increasing of FIO2 or Guedel airway insertion) in MAC and IAP than EDP, p = 0.003. The tracheal intubation was most frequent in MAC: 1.8%, p = 0.074. Concerning effectiveness, the highest cancelled ERCP rate was observed in MAC: 2.9%, p = 0.015. Similarly, in this group the lateral decubitus position was most frequent (31.6%, p = 0.000), which determined the worst radiologic image (17.8%, p = 0.000). The sedation time was shortest in IAP: 44.4 ± 1.8 min, p = 0.023.

Conclusions:

Our data suggest that sERCP is safer and more effective when is administered by an expert nursing team directed by an endoscopist.