Endoscopy 2007; 39(4): 345-349
DOI: 10.1055/s-2006-945195
Original article

© Georg Thieme Verlag KG Stuttgart · New York

The effect of sedation on the quality of upper gastrointestinal endoscopy: an investigator-blinded, randomized study comparing propofol with midazolam

A.  Meining1 , V.  Semmler1, 2 , A.  M.  Kassem3 , R.  Sander2 , U.  Frankenberger2 , M.  Burzin4 , J.  Reichenberger1 , M.  Bajbouj1 , C.  Prinz1 , R.  M.  Schmid1
  • 1Medical Department II, Technical University of Munich, Munich, Germany
  • 2Gastropraxis Harlaching, Munich, Germany
  • 3Tropical Medicine and GI-Endoscopy Departments, Faculty of Medicine, Cairo, Egypt
  • 4Medical Department, Klinikum Freising, Freising, Germany
Further Information

Publication History

submitted 3 July 2006

accepted after revision 17 November 2006

Publication Date:
07 February 2007 (online)

Background and study aims: Sedation with propofol is associated with a high acceptance rate in upper gastrointestinal endoscopy. So far, however, there are no valid data on whether the use of propofol can increase the general quality of the endoscopic examination.

Patients and methods: A total of 60 patients referred for upper gastrointestinal endoscopy were randomized to receive sedation with either midazolam (n = 30) or propofol (n = 30). The maximum dosages permitted were 5 mg of midazolam and 500 mg of propofol. The examinations were recorded on videotapes, and the quality of upper endoscopy was assessed by videotape analysis by three experienced endoscopists who were all blinded to patient data and the medications used for sedation. A score sheet was used with 18 assessment items that each represented a step of upper gastrointestinal endoscopy and a global score for the entire examination. A scale ranging from 1 (excellent) to 6 (very poor) was used. Data were analyzed on an intention-to-investigate basis: inability to perform the procedure because of a patient’s intolerance of the procedure, for example, was scored as 6 (i. e. very poor).

Results: Patients in the two groups were well matched with respect to demographic and clinical data. Four patients in the midazolam group could not be adequately examined. The median dosage used for sedation was 5 mg midazolam (range 2 - 5 mg) and 160 mg propofol (range 70 - 320 mg). When assessments by all three blinded examiners were added together, propofol sedation was found to result in significantly better scores for all parameters except for the assessments of “Z-line/cardia”, “duodenal bulb”, and “duodenal folds” (all P < 0.05, Mann-Whitney U test).

Conclusion: Sedation with propofol might increase the quality of upper endoscopy. This finding may have a significant impact on the selection of the type of sedation, not only in terms of increasing patients’ acceptance of the procedure, but also for improving the diagnostic accuracy of upper gastrointestinal endoscopy.

References

  • 1 Abraham N, Fallone C A, Mayrand S. et al . Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy: a Canadian randomized controlled cost-outcome study.  Am J Gastroenterol. 2004;  99 1692-1699
  • 2 Faulx A L, Vela S, Das A. et al . The changing landscape of practice patterns regarding unsedated endoscopy and propofol use: a national web survey.  Gastrointest Endosc. 2005;  62 993
  • 3 Ristikankare M, Kartikainen J, Heikkinen M, Julkunen R. Is routine sedation or topical pharyngeal anesthesia beneficial during upper endoscopy?.  Gastrointest Endosc. 2004;  60 686-694
  • 4 Lazzaroni M, Bianchi Porro  G. Preparation, premedication and surveillance.  Endoscopy. 2003;  35 103-111
  • 5 Heuss L T, Froehlich F, Beglinger C. Changing patterns of sedation and monitoring practice during endoscopy: results of a nationwide survey in Switzerland.  Endoscopy. 2005;  37 161-166
  • 6 Jung M, Hofmann C, Kiesslich R, Brackertz A. Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam.  Endoscopy. 2000;  32 233-238
  • 7 Hofmann C, Kiesslich R, Brackertz A, Jung M. Propofol for sedation in gastroscopy: a randomized comparison with midazolam.  Z Gastroenterol. 1999;  37 589-595
  • 8 Riphaus A, Stergiou N, Wehrmann T. Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study.  Am J Gastroenterol. 2005;  100 1957-1963
  • 9 Carlsson U, Grattidge P. Sedation for upper gastrointestinal endoscopy: a comparative study of propofol and midazolam.  Endoscopy. 1995;  27 240-243
  • 10 Krugliak P, Ziff B, Rusabrov Y. et al . Propofol versus midazolam for conscious sedation guided by processed EEG during endoscopic retrograde cholangiopancreatography: a prospective, randomized, double-blind study.  Endoscopy. 2000;  32 677-682
  • 11 Chen W X, Lin H J, Zhang W F. et al . Sedation and safety of propofol for therapeutic endoscopic retrograde cholangiopancreatography.  Hepatobiliary Pancreat Dis Int. 2005;  4 437-440
  • 12 Byrne M F, Baillie J. Nurse-assisted propofol sedation: the jury is in!.  Gastroenterology. 2005;  129 1781-1792
  • 13 Kulling D, Rothenbuhler R, Inauen W. Safety of nonanesthesist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy.  Endoscopy. 2003;  35 679-682
  • 14 Saenz-Lopez S, Rodriguez Munoz S, Rodriguez-Alcalde D. et al . Endoscopist controlled administration of propofol: an effective and safe method of sedation in endoscopic procedures.  Rev Esp Enferm Dig. 2006;  98 25-35
  • 15 Rex D K, Heuss L T, Walker J A, Qi R. Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy.  Gastroenterology. 2005;  129 1384-1391
  • 16 American Society for Gastrointestinal Endoscopy . Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy.  Gastrointest Endosc. 2003;  58 317-322
  • 17 Hofmann C, Jung M. Sedierung und Überwachung bei endoskopischen Eingriffen. Guidelines of the endoscopic section of the German Society for Digestive and Metabolic Diseases. Available from: http://www.dgvs.de/media/1.2.Sedierung-ueberwachung.pdf
  • 18 Neumann M, Friedl S, Meining A. et al . A score card for upper gastrointestinal endoscopy: evaluation of interobserver variability in examiners with various levels of experience.  Z Gastroenterol. 2002;  40 857-862
  • 19 Ulmer B J, Hansen J J, Overley C A. et al . Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists.  Clin Gastroenterol Hepatol. 2003;  1 425-432
  • 20 Qadeer M A, Vargo J J, Khandwala F. et al . Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis.  Clin Gastroenterol Hepatol. 2005;  3 1049-1056
  • 21 Yusoff I F, Raymond G, Sahai A V. Endoscopist administered propofol for upper gastrointestinal EUS is safe and effective: a prospective study in 500 patients.  Gastrointest Endosc. 2004;  60 356-360

A. Meining, MD

Medizinische Klinik II

Technical University of Munich

Klinikum rechts der Isar

Ismaningerstr. 22

D-81675 Munich

Germany

Fax: +49-89-4140-4905

Email: alexander.meining@lrz.tum.de

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