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DOI: 10.1055/s-0042-1745309
ENDOSCOPIC ULTRASOUND (EUS) AND ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PERFORMED IN THE SAME SESSION DON’T INCREASE THE RISK OF SEDATION-RELATED COMPLICATIONS
Aims To compare the risk of sedation-related complications of EUS and ERCP performed in the same vs. separate sessions
Methods Our study included all patients with EUS and ERCP performed within five days between 01/2017-10/2021.
Deep sedation was performed with propofol and midazolam in all cases(bolus regime) by a non-anesthesiologist(registered nurse or physician). Use of opioids(nalbuphine) was also documented.
Sedation-related complications were defined as cardiorespiratory instability with a sustained reduction in oxygen saturation to less than 90% and/or prolonged hypotension or bradycardia.
Results 291 EUS+ERCP cases were performed during the study period, but 29 were excluded(5 cases both EUS+ERCP in general anesthesia,18 cases with deep sedation by EUS, but ERCP with general anesthesia,3 cases with sedation related complications by EUS,and 2 cases with difficult sedation by EUS which further received ERCP in general anesthesia).
The mean age of patients was 69.1±15.9 year(51.9% male,32.1% ASA III score).Indication of procedure was: choledocholithiasis–56.1%, pancreaticobiliary malignancy-29.7%, and other benign diseases–14.2%. EUS-FNA was performed in 27.4% of cases.
The two cohorts(ERCP+EUS in same vs separate sessions) were similar regarding age, gender, ASA classification, EUS+ERCP indication, or performance of EUS-FNA.
The sedation-related complications were similar between the two cohorts, but the duration of EUS+ERCP in one session was shorter and less midazolam and nalbuphine were used when the procedures were performed in the same session
EUS+ERCP in the same session (n=131) |
EUS and ERCP in different sessions (n=131) |
p value |
|
---|---|---|---|
Sedation related complications (%) |
2.3 |
1.5 |
0.98 |
Duration of the two procedures (min) |
56.4±20.8 |
63.9±18.9 |
0.008 |
Propofol (mg)/Midazolam (mg) |
350 (100–1790)/4 (2–10) |
340 (130–910)/5 (1–10) |
0.77/<0.0001 |
Use of nalbuphine (%) |
17.5 |
39.6 |
0.0001 |
Conclusions Performance of EUS and ERCP in the same session did not increase the rate of sedation-related complications and seems to be associated with shorter duration of the interventions and sedation dose.
Publication History
Article published online:
14 April 2022
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