Quality Assurance in Endoscopy Should Include Data on Sedation

We read with great interest the recent article by Naylor et al. on ”Setting up a quality assurance program in endoscopy” [1] and we strongly agree with the authors that major improvements should be made in assessing the quality and outcome of endoscopy.

While the authors emphasize that all relevant information should be compiled in a single database, we were surprised to see that all data relating to sedation were handled separately in their project. Although the amount of routinely collected data should be kept as small as possible, it is widely accepted that a growing part of more invasive procedures are not feasible without lowering the patient’s level of consciousness. In addition, sedation-related complications may account for up to 50 % of the procedure-related complications and should therefore be regarded as a part of the procedure [2]. In our own database (which includes 9817 procedures), we identified 91 acute complications (0.9 %): 49 were related to the procedure, 26 to sedation, and 16 to other aspects. Including sedation data in a single database also makes sense as it has been shown that the assessment of the American Society of Anesthesiologists (ASA) status may be useful for estimating the required dosage of sedative drugs before endoscopy [3]. We would therefore encourage any design of an electronic outcome database that would make it possible to collect not only procedural, but also sedation parameters.

References

• 1 Naylor G, Gatta L, Butler A. et al . Setting up a quality assurance program in endoscopy.  Endoscopy. 2003;  35 701-707
• 2 Bell G D. Premedication, preparation, and surveillance.  Endoscopy. 2002;  34 2-12
• 3 Heuss L T, Schnieper P, Drewe J. et al . Risk stratification and safe administration of propofol by registered nurses supervised by the gastroenterologist: a prospective observational study of more than 2000 cases.  Gastrointest Endosc. 2003;  57 664-671