Endoscopic retrograde cholangiopancreatography under moderate sedation and factors predicting need for anesthesiologist directed sedation: A county hospital experience

Table 1 Endoscopic retrograde cholangiopancreatography-degree of difficulty

Grade	Diagnostic	Therapeutic
Grade 1: standard	Deep cannulation, diagnostic sampling	Biliary sphincterotomy, stones < 10 mm, stents for leaks and low tumors.
Grade 2: advanced	Billroth II diagnostics, minor papilla cannulation	Stones > 10 mm, hilar tumor stent placement, benign biliary strictures
Grade 3: tertiary	Manometry, Whipple, Roux en Y, intraductal endoscopy	Billroth II therapeutics, intrahepatic stones, pancreatic therapies

The date was quoted by the reference of 3.

Table 2 Patient demographics

Demographic	n (%)
Gender
Males	234 (48)
Females	252 (52)
Race
Hispanic	189 (39)
Non hispanic black	179 (37)
White	91 (19)
Asian	20 (4)
Unspecified	7 (1.5)
Alcohol use	225 (46)
Other illicit substance use	79 (16)

Table 3 Causes of endoscopic retrograde cholangiopancreatography failure with gastroenterologist directed sedation n (%)

Cause
Total number of patients undergoing GDS	486
Patient intolerance	68 (14)
Cardiopulmonary complications	10 (2)
Hypertension	6 (1.2)
Hypoxia, hypotension, bradycardia or tachycardia	4 (0.8)
Failure to cannulate	40 (8)
Food/contrast in lumen	8 (1.6)
Roux en Y anatomy	2 (0.4)
Esophageal bleeding on entry	1 (0.2)

GDS: Gastroenterologist directed sedation.

Table 4 Patient variables predicting failure with gastroenterologist directed sedation for endoscopic retrograde cholangiopancreatographies

Patient variables	MS	MS failure	P value	Patient variables1	MS	MS failure	P value
Substance abuse	31	13	0.003
Male	131	25	0.01	Male1	104	14	0.09
Female	157	12		Female1	153	10
Race				Race1
AA	79	22	0.001	AA	61	10	0.06
White	42	6	0.8	White	38	6	0.2
Hispanic	142	8	0.001	Hispanic	134	7	0.04
Asian	15	1	0.5	Asian	15	1	0.7
> 65 yr	37	2	0.15	> 65 yr1	33	1	0.16
≤ 65 yr	251	35		≤ 65 yr1	224	23
Alcohol use	113	21	0.04	Alcohol use1	87	11	0.24
No alcohol use	175	16		No alcohol use1	170	13
Bilirubin-elevated	252	44	0.03	Bilirubin-elevated1	222	34	0.45
Bilirubin-normal	146	43		Bilirubin-normal1	126	24

¹Adjusted for substance abuse. MS: Moderate sedation.

Table 5 Odds ratios for failure with gastroenterologist directed sedation by indication of the procedure

Indication	n (%)	OR (95%CI)	Adjusted OR (95%CI)1
Gallstones/cholangitis	231 (38)	0.6 (0.4, 1.0)	0.7 (0.4, 1.3)
All strictures	125 (20)	1.5 (0.9, 2.4)	1.6 (0.9, 2.9)
Benign strictures	53 (9)	2.2 (1.2, 4.2)	2.7 (1.2, 5.7)
Suspected malignancy	72 (12)	0.9 (0.5, 1.8)	0.9 (0.4, 2.0)
Abn LFTs	36 (6)	0.6 (0.2, 1.6)	0.5 (0.12, 2.3)
Pancreatic	11 (2)	2.7 (0.8, 9.4)	3.7 (0.9, 16)
Other	7 (1)	1.8 (0.4, 9.7)	2.5 (0.5, 12.9)
Post cholecystectomy stone/leak	24 (4)	0.4 (0.1, 1.7)	0.3 (0.0, 2.0)
Exchange/incomplete	51 (8)	2.1 (1.1, 4.0)	0.9 (0.3, 2.5)
	485

¹Adjusted to substance abuse. OR: Odds ratio.

Table 6 Multivariate analysis of predictors of failure with gastroenterologist directed sedation

Variable	βcoefficient	P value	OR (95%CI)
Grade of procedure (1-3)1	0.75	0.002	2.1 (1.3, 3.4)
Substance abuse1	1.03	0.001	2.8 (1.5, 5)
Indication
Strictures	0.13	0.687	1.1 (0.6, 2.1)
Gallstone	-0.18	0.563	0.8 (0.5, 1.5)
Alcohol use	0.33	0.267	1.4 (0.8, 2.5)
Female gender	-0.29	0.33	0.7 (0.4, 1.3)

¹ Significant variables in the multivariate model.