CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(04): E315-E320
DOI: 10.1055/s-0043-104858
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Patients with primary sclerosing cholangitis require more sedation during endoscopic retrograde cholangiography

Carsten Keil
1   Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
,
Lukas Aguirre Dávila
2   Institute for Biostatistics, Hannover Medical School, Hannover, Germany
,
Theodor Framke
2   Institute for Biostatistics, Hannover Medical School, Hannover, Germany
,
Henrike Lenzen
1   Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
,
Michael P. Manns
1   Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
,
Tim O. Lankisch
1   Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
,
Torsten Voigtländer
1   Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
› Author Affiliations
Further Information

Publication History

submitted 01 June 2016

accepted after revision 30 December 2016

Publication Date:
06 April 2017 (online)

Abstract

Background and study aims Patients with primary sclerosing cholangitis (PSC) require repeated endoscopic retrograde cholangiography (ERC). Our aim was to evaluate whether patients with PSC require higher doses of sedation during ERC.

Patients and methods We retrospectively analyzed all patients undergoing ERC from 2006 to 2013 who received conscious sedation with propofol and midazolam. The duration of the intervention and a potential progression of propofol consumption or intervention time by visit number were analyzed. Univariable and multivariable analyses were performed to identify independent factors which influence propofol consumption.

Results A total of 2962 ERC procedures were performed in 1211 patients. Patients with PSC (n = 157) underwent 461 ERC procedures whereas patients without PSC (n = 1054) had 2501 ERC examinations. The total median propofol dose was 450 mg (290 – 630 mg) for patients with PSC and 300 mg (200 – 450 mg) for the non-PSC group (P < 0.05). The propofol consumption in patients with PSC was increased by a factor of 1.24 (P = 0.0071) independent of intervention time. Younger age (< 60.8 years) and duration of the intervention were associated with a higher need for sedation by factors of 1.21 and 1.71, respectively (P < 0.0001). The robustness of the results was tested in a sensitivity analysis which confirmed the results (P < 0.0001).

Conclusions Patients with PSC may require higher doses of sedation for ERC compared to other patient groups independent of age and duration of ERC. The higher dosage of sedation has to be taken into account when using ERC to treat a patient with PSC.

 
  • References

  • 1 Trauner M, Halilbasic E, Baghdasaryan A. et al. Primary sclerosing cholangitis: new approaches to diagnosis, surveillance and treatment. Dig Dis 2012; 30 (Suppl. 01) 39-47
  • 2 Karlsen TH, Boberg KM. Update on primary sclerosing cholangitis. J Hepatol 2013; 59: 571-582
  • 3 Boberg KM, Lind GE. Primary sclerosing cholangitis and malignancy. Best Pract Res Clin Gastroenterol 2011; 25: 753-764
  • 4 Karlsen TH, Vesterhus M, Boberg KM. Review article: controversies in the management of primary biliary cirrhosis and primary sclerosing cholangitis. Aliment Pharmacol Ther 2014; 39: 282-301
  • 5 Voigtländer T, Lankisch TO. Endoscopic diagnosis of cholangiocarcinoma: From endoscopic retrograde cholangiography to bile proteomics. Best Pract Res Clin Gastroenterol 2015; 29: 267-275
  • 6 Chapman MH, Webster GJ, Bannoo S. et al. Cholangiocarcinoma and dominant strictures in patients with primary sclerosing cholangitis: a 25-year single-centre experience. Eur J Gastroenterol Hepatol 2012; 24: 1051-1058
  • 7 Modha K, Navaneethan U. Diagnosis and management of primary sclerosing cholangitis – perspectives from a therapeutic endoscopist. World J Hepatol 2015; 7: 799-805
  • 8 Moon JH, Choi HJ, Lee YN. Endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 2014; 80: 388-391
  • 9 Chavalitdhamrong D, Donepudi S, Pu L. et al. Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography. Dig Endosc 2014; 26: 15-22
  • 10 Ferreira AO, Cravo M. Sedation in gastrointestinal endoscopy: Where are we at in 2014?. World J Gastrointest Endosc 2015; 7: 102-109
  • 11 Obara K, Haruma K, Irisawa A. et al. Guidelines for sedation in gastroenterological endoscopy. Dig Endosc 2015; 27: 435-449
  • 12 Raymondos K, Panning B, Bachem I. et al. Evaluation of endoscopic retrograde cholangiopancreatography under conscious sedation and general anesthesia. Endoscopy 2002; 34: 721-726
  • 13 Cheriyan DG, Byrne MF. Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. World J Gastroenterol 2014; 20: 5171-5176
  • 14 Thosani N, Banerjee S. Endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis. Clin Liver Dis 2014; 18: 899-911
  • 15 Sweeney BP, Bromilow J. Liver enzyme induction and inhibition: implications for anaesthesia. Anaesthesia 2006; 61: 159-177
  • 16 Tanaka E. Clinically important pharmacokinetic drug-drug interactions: role of cytochrome P450 enzymes. J Clin Pharm Ther 1998; 23: 403-416
  • 17 Andriulli A, Loperfido S, Napolitano G. et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 102: 1781-1788
  • 18 Li T, Apte U. Bile acid metabolism and signaling in cholestasis, inflammation, and cancer. Adv Pharmacol 2015; 74: 263-302
  • 19 Trauner M, Halilbasic E, Kazemi-Shirazi L. et al. Therapeutic role of bile acids and nuclear receptor agonists in fibrosing cholangiopathies. Dig Dis 2014; 32: 631-636
  • 20 Rivera R, Antognini JF. Perioperative drug therapy in elderly patients. Anesthesiology 2009; 110: 1176-1181
  • 21 Travis AC, Pievsky D, Saltzman JR. Endoscopy in the elderly. Am J Gastroenterol 2012; 107: 1495-1501
  • 22 Rooke GA. Cardiovascular aging and anesthetic implications. J Cardiothorac Vasc Anesth 2003; 17: 512-523
  • 23 Shafer SL. The pharmacology of anesthetic drugs in elderly patients. Anesthesiol Clin North America 2000; 18: 1-29 , v
  • 24 Schnider TW, Minto CF, Shafer SL. et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90: 1502-1516
  • 25 Vargo JJ. Procedural sedation and obesity: waters left uncharted. Gastrointest Endosc 2009; 70: 980-984
  • 26 Kongkam P, Rerknimitr R, Punyathavorn S. et al. Propofol infusion versus intermittent meperidine and midazolam injection for conscious sedation in ERCP. J Gastrointest Liver Dis 2008; 17: 291-297
  • 27 Jung M, Hofmann C, Kiesslich R. et al. Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam. Endoscopy 2000; 32: 233-238
  • 28 Vargo JJ, Zuccaro Jr G, Dumot JA. et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology 2002; 123: 8-16