THE EFFECT OF SEDATION ON THE QUALITY OF UPPER GASTROINTESTINAL ENDOSCOPY

Aims:

Several performance measures for colonoscopy have been identified leading to a significant improvement in quality. The European Society of Gastrointestinal Endoscopy (ESGE) have proposed similar measures for oesophago-gastro-duodenoscopy (OGD). Two of the proposed measures include inspection time of ≥7 minutes, and photo documentation comprising ≥10 images. Patients' intolerance of the procedure could affect procedure length and limit thorough mucosal examination. We aimed to compare OGD performance measures in sedated and unsedated patients.

Methods:

OGD performance data from a tertiary teaching hospital was retrospectively collected from the electronic endoscopic reporting system from January 2013 to October 2016. Data was analysed using SPSS.

Results:

10,482 procedures were included for analysis. 11.4% had accurate photo documentation (≥10 images, target > 90%) with a median of 5 images. 75.35% had adequate inspection time (≥7 minutes, target > 90%) with a median of 10 minutes.

Median inspection time for sedated procedures was 10 minutes vs. 8 minutes for unsedated procedures. 78% of sedated procedures met the target of 7 minute inspection time vs. 66% of unsedated procedures (p-value < 0.001). Both groups had a median of 5 images recorded. 12% of sedated procedures recorded ≥10 images vs. 8% of unsedated procedures (p-value < 0.001).

Conclusions:

The use of sedation is associated with significantly improved performance measures. One third of unsedated OGDs failed to meet the target inspection time. Adherence to the proposed performance measures would favour the use of sedation leading to increased use of resources.