Endoscopy 2022; 54(S 01): S256
DOI: 10.1055/s-0042-1745309
Abstracts | ESGE Days 2022
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ENDOSCOPIC ULTRASOUND (EUS) AND ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PERFORMED IN THE SAME SESSION DON’T INCREASE THE RISK OF SEDATION-RELATED COMPLICATIONS

S. Bota
1   Klinikum Klagenfurt am Wörthersee, Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klagenfurt, Austria
,
M. Razpotnik
1   Klinikum Klagenfurt am Wörthersee, Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klagenfurt, Austria
,
C. Urak
1   Klinikum Klagenfurt am Wörthersee, Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klagenfurt, Austria
,
G. Essler
1   Klinikum Klagenfurt am Wörthersee, Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klagenfurt, Austria
,
J. Weber-Eibel
1   Klinikum Klagenfurt am Wörthersee, Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klagenfurt, Austria
,
M. Peck-Radosavljevic
1   Klinikum Klagenfurt am Wörthersee, Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klagenfurt, Austria
› Author Affiliations
 

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

Table 1

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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