Letter To The Editor
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2017; 23(3): 560-562
Published online Jan 21, 2017. doi: 10.3748/wjg.v23.i3.560
Endoscopic ultrasound sedation in the United Kingdom: Is life without propofol tolerable?
Jennifer Anne Campbell, Andrew James Irvine, Andrew Derek Hopper
Jennifer Anne Campbell, Andrew James Irvine, Andrew Derek Hopper, Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom
Author contributions: Campbell JA wrote this letter, analysed and interpreted data; Irvine AJ and Hopper AD contributed to conception and design of the study, acquisition of data, and analysis and interpretation of data and approved the final version of the article to be published.
Conflict-of-interest statement: All authors are employed by Sheffield Teaching Hospitals NHS Foundation Trust. No funding was required for this study and there are no competing interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jennifer A Campbell, Department of Gastroenterology, Royal Hallamshire Hospital, Room P39, Glossop Road, Sheffield S10 2JF, United Kingdom. jennifer.campbell@sth.nhs.uk
Telephone: +44-114-2712353 Fax: +44-114-2712692
Received: October 4, 2016
Peer-review started: October 7, 2016
First decision: November 9, 2016
Revised: November 15, 2016
Accepted: December 2, 2016
Article in press: December 2, 2016
Published online: January 21, 2017
Abstract

There is compelling evidence to support the quality, cost effectiveness and safety profile of non-anesthesiologist-administered propofol for endoscopic ultrasound (EUS). However in the United Kingdom, it is recommended that the administration and monitoring of propofol sedation for endoscopic procedures should be the responsibility of a dedicated and appropriately trained anaesthetist only. The majority of United Kingdom EUS procedures are performed with opiate and benzodiazepine sedation rather than anaesthetist led propofol lists due to anaesthetist resource availability. We sought to prospectively determine the tolerability and safety of EUS with benzodiazepine and opiate sedation in single United Kingdom centre. Two hundred consecutive patients undergoing either EUS or oesophago-gastroduodenoscopy (OGD) with conscious sedation were prospectively recruited with a 1:1 enrolment ratio. Patients completed questionnaires pre and post procedure detailing anticipated and actual pain experienced on a 1-10 visual analogue scale. Demographics, procedure duration, sedation doses and willingness to repeat the procedure were also recorded. EUS procedures lasted significantly longer than OGDs (15 min vs 6 min, P < 0.0001), however, there was no difference in anticipated pain scores between the groups (EUS 3.37/10 vs OGD 3.47/10, P = 0.46). Pain scores indicated EUS was better tolerated than OGD (1.16/10 vs 1.88/10, P = 0.03) although higher doses of sedation were used for EUS procedures. There were no complications identified in either group. We feel our study demonstrates that the tolerability of EUS with opiate and benzodiazepine sedation is acceptable.

Keywords: Sedation, Endoscopy, Tolerability, Propofol, Endoscopic ultrasound

Core tip: Strong evidence exists to support safety and tolerability of non-anaesthesiologist-administered propofol for endoscopic ultrasound (EUS) procedures. United Kingdom guidelines, however, recommend propofol is administered only by anaesthesiologists. Consequently, in the United Kingdom, nearly all EUS procedures are performed with combinations of benzodiazepine and opiate sedation for which little tolerability data exists. This letter shares the experience of a single EUS centre using benzodiazepine and opiate sedation demonstrating it can be safe and the resulting tolerability acceptable.