Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10398
Peer-review started: August 19, 2016
First decision: October 20, 2016
Revised: November 3, 2016
Accepted: November 28, 2016
Article in press: November 28, 2016
Published online: December 21, 2016
To examine whether high-flow nasal oxygen (HFNO) availability influences the use of general anesthesia (GA) in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) and associated outcomes.
In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras (era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era (era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.
During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3 (P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3 (P < 0.001) but not between eras 1 and 2 (P = 0.028) or 1 and 3 (P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation (P≤ 0.007) as was the anesthesia-only time (P≤ 0.001).
High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.
Core tip: This retrospective study demonstrates a decreased use of GA when HFNO is available in the endoscopy unit for patients undergoing endoscopic retrograde cholangiopancreatography and endoscopic ultrasound under sedation. Provision of HFNO and deep sedation was associated with decreased procedure and anesthesia-only times, and oxygenation was improved compared to sedation without HFNO. These findings justify further prospective trials to fully elucidate the role of HFNO during sedation in gastrointestinal endoscopy. HFNO may have the potential to alter sedation practices in the endoscopy suite.