Published online Apr 16, 2021. doi: 10.4253/wjge.v13.i4.97
Peer-review started: January 6, 2021
First decision: February 11, 2021
Revised: February 19, 2021
Accepted: March 11, 2021
Article in press: March 11, 2021
Published online: April 16, 2021
With increasing volume and cost of gastrointestinal endoscopic procedures, the proper selection of patients for moderate sedation becomes increasingly relevant. The current literature lacks consistent findings that allow for appropriate selection of patients for moderate sedation.
To analyze a nationwide registry of patients to identify patient and procedural factors associated with lower sedation requirements for endoscopy.
The Clinical Outcomes Research Initiative National Endoscopic Database was queried to assess adult patients undergoing moderate sedation for esophagogastroduodenoscopy (EGD) and colonoscopy from 2008 to 2014. Patients were stratified into two groups [low dose (LD) and high dose sedation] based on sedation requirements. Anthropometric, procedural, and anesthesia data were compared, and multivariable analysis was performed to identify factors associated with LD sedation.
Of the 371102 patients included in the study, 63137 where stratified into the LD sedation group and 307965 were in the high dose group. Moderate sedation was managed primarily by endoscopists (50%) and anesthesia providers (47%). Patients undergoing EGDs and procedures performed in the inpatient setting, in ambulatory surgery centers, intensive care units or hospital wards, required less sedation than colonoscopies, outpatient procedures and procedures done in endoscopy suites, respectively (P < 0.0001 for all). On multivariable analysis, factors predictive of tolerance with lower sedation requirements for EGDs and colonoscopies were female gender, age ≥ 50, non-White race, Hispanic descent, body mass index ≤ 25 kg/m2, and higher American Society of Anesthesia Class (P < 0.0001 for all).
Clinicians should consider these patient profiles in determining which patients will better tolerate moderate sedation vs those better suited for alternative sedation methods.
Core Tip: Limited society guidelines currently exist to aid endoscopists in the selection of the most appropriate sedation method. Rather, it is at the discretion of the endoscopist on a case-by-case basis, with many decisions made based on gut feeling and previous personal experience. With the growing focus on patient satisfaction as a metric for reimbursement and an increased focus on healthcare cost containment initiatives, identifying which patients can safely and effectively undergo endoscopy without anesthesia-administered sedation is becoming exceedingly important. Existing studies on this topic to date have been small scale, single-center data with inconsistent findings. Robust data to drive practice patterns have been lacking. As such, we have capitalized upon nationwide data found in the Clinical Outcomes Research Initiative National Endoscopic Database to clarify these discrepancies and to identify patient and procedure characteristics that may predict better patient tolerance to endoscopy with moderate sedation.