Published online Feb 16, 2021. doi: 10.4253/wjge.v13.i2.45
Peer-review started: December 4, 2020
First decision: December 18, 2020
Revised: December 31, 2020
Accepted: January 21, 2021
Article in press: January 21, 2021
Published online: February 16, 2021
Foreign object ingestion (FOI) and food bolus impaction (FBI) are common causes of emergent endoscopic intervention. However, the choice of sedation used during emergent endoscopy for foreign bodies is often dictated by physician experience.
Currently, there is insufficient data examining the safety of different sedation modalities in emergent endoscopy for removal of ingested foreign objects or FBI.
To investigate the complication rates of emergent endoscopic extraction performed under different sedation modalities, namely conscious sedation (CS), monitored anesthesia care (MAC) and general anesthesia (GA).
A standardized questionnaire was utilized to collect data on demographics, endoscopic details, sedation practices, hospital stay and adverse events of endoscopic procedures for foreign body removal. Subsequently, complication rates of patients who underwent emergent endoscopic retrieval were compared based on sedation modalities.
Among the 929 procedures analyzed, 353 procedures (38.0%) were performed under CS, 278 procedures (29.9%) under MAC and the rest (32.1%) under GA. Analysis revealed no statistically significant difference in the complication rate between patients sedated under CS (14.7%), MAC (14.7%) and GA (19.5%), P = 0.19. However, patients that underwent MAC and GA were found to be more likely to require hospitalization. This may be due to longer inpatient psychiatric monitoring as many patients who underwent MAC and GA presented with FOI due to underlying psychiatric disorder.
Emergent endoscopy for foreign body removal under CS is not associated with significantly higher complication rates compared to MAC and GA.
Future prospective studies are needed to identify various clinical factors that contributes to higher risk for endoscopy-related adverse events.