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Year 2016 / Volume 108 / Number 5
Original

Safety and risk factors for difficult endoscopist-directed ERCP sedation in daily practice: a hospital-based case-control study

240-245

DOI: 10.17235/reed.2016.4206/2016

Enrique Pérez-Cuadrado Robles, Abel González Ramírez, Ángel Lancho Seco, Eva Martí Marqués, Andrés Dacal Rivas, Elena Castro Ortiz, Roberto González Soler, Beatriz Álvarez Suárez, Dolores Tardáguila García, Alina López Baz, Alexia Fernández López, Leopoldo López Roses,

Abstract

Background: There are limited data concerning endoscopist-directed endoscopic retrograde cholangiopancreatography deep sedation. The aim of this study was to establish the safety and risk factors for difficult sedation in daily practice. Patients and methods: Hospital-based, frequency matched case-control study. All patients were identified from a database of 1,008 patients between 2014 and 2015. The cases were those with difficult sedations. This concept was defined based on the combination of the receipt of high-doses of midazolam or propofol, poor tolerance, use of reversal agents or sedation-related adverse events. The presence of different factors was evaluated to determine whether they predicted difficult sedation. Results: One-hundred and eighty-nine patients (63 cases, 126 controls) were included. Cases were classified in terms of high-dose requirements (n = 35, 55.56%), sedation-related adverse events (n = 14, 22.22%), the use of reversal agents (n = 13, 20.63%) and agitation/discomfort (n = 8, 12.7%). Concerning adverse events, the total rate was 1.39%, including clinically relevant hypoxemia (n = 11), severe hypotension (n = 2) and paradoxical reactions to midazolam (n = 1). The rate of hypoxemia was higher in patients under propofol combined with midazolam than in patients with propofol alone (2.56% vs. 0.8%, p < 0.001). Alcohol consumption (OR: 2.674 [CI 95%: 1.098-6.515], p = 0.030), opioid consumption (OR: 2.713 [CI 95%: 1.096-6.716], p = 0.031) and the consumption of other psychoactive drugs (OR: 2.015 [CI 95%: 1.017-3.991], p = 0.045) were confirmed to be independent risk factors for difficult sedation. Conclusions: Endoscopist-directed deep sedation during endoscopic retrograde cholangiopancreatography is safe. The presence of certain factors should be assessed before the procedure to identify patients who are high-risk for difficult sedation.

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Letter

Temporomandibular joint dislocation after an upper endoscopy: a complication to consider

DOI: 10.17235/reed.2019.6561/2019

Original

Factors associated with the presence of abnormal levels of fecal calprotectin in patients with negative panenteric studies

DOI: 10.17235/reed.2020.6508/2019

Letter

Primary gastric choriocarcinoma

DOI: 10.17235/reed.2020.6478/2019

Letter

Pancreatic metastasis of Merkel-cell carcinoma: a rare neoplasm of the pancreas

DOI: 10.17235/reed.2020.6467/2019

Digestive Diseases Image

Gastrointestinal bleeding due to duodenal mucormycosis in an immunocompetent host mimicking malignancy

DOI: 10.17235/reed.2019.6462/2019

Original

Lewis score: a useful tool for diagnosis and prognosis in Crohn’s disease

DOI: 10.17235/reed.2020.6434/2019

Original

Randomized clinical trial to assess the mPADSS scale in recovery and home discharge after endoscopy

DOI: 10.17235/reed.2020.6420/2019

Digestive Diseases Image

Jejunal schwannoma detected by video capsule endoscopy

DOI: 10.17235/reed.2020.6474/2019

Original

Detection of polyps in the small bowel of patients with acromegaly via capsule endoscopy

DOI: 10.17235/reed.2020.6377/2019

Digestive Diseases Image

Capsule endoscopy, a useful tool for the diagnosis of a tapeworm infection

DOI: 10.17235/reed.2019.6346/2019

Editorial

Endoscopy units – Statu quo

DOI: 10.17235/reed.2019.6347/2019

Letter

Endoscopically diagnosed systemic mastocytosis

DOI: 10.17235/reed.2019.6246/2019

Original

The effect of a preoperative biliary prosthesis on the infectious complications of the pancreaticoduodenectomy

DOI: 10.17235/reed.2019.6228/2019

Letter

Endoscopic balloon dilation in duodenal stenosis secondary to intestinal lymphoma in a heart transplant patient

DOI: 10.17235/reed.2019.6221/2019

Digestive Diseases Image

A rare heterotopic gastric mucosa appearing between the muscularis mucosae and submucosa

DOI: 10.17235/reed.2019.6134/2018

Special Article

Quality indicators in gastroscopy. Gastroscopy procedure

DOI: 10.17235/reed.2019.6023/2018

Letter

Endoscopic management of Boerhaave’s syndrome

DOI: 10.17235/reed.2019.6013/2018

Letter

Pyogenic granuloma of the duodenum as an unusual cause of gastrointestinal bleeding

DOI: 10.17235/reed.2019.5977/2018

Original

Influence of demographic and clinical features of the patient on transit times and impact the on the diagnostic yield of capsule endoscopy

DOI: 10.17235/reed.2019.5971/2018

Digestive Diseases Image

Intraductal papillary mucinous neoplasm of the main duct in a patient with pancreas divisum

DOI: 10.17235/reed.2019.5959/2018

Letter

Use of patency capsule in daily practice

DOI: 10.17235/reed.2019.5952/2018

Original

Bariatric and metabolic endoscopy in the handling of fatty liver disease. A new emerging approach?

DOI: 10.17235/reed.2019.5949/2018

Original

Small bowel transit time of capsule endoscopy as a factor for the detection of lesions in potential small bowel bleeding

DOI: 10.17235/reed.2019.5943/2018

Original

Metastatic tumors in the pancreas: the role of endoscopic ultrasound-guided fine‐needle aspiration

DOI: 10.17235/reed.2019.5914/2018

Digestive Diseases Image

Treatment of gastric GIST using endoscopic techniques combined with the application of endoloop and intralesional cyanoacrylate in a non-surgical patient

DOI: 10.17235/reed.2018.5899/2018

Letter

Multiple biliary hamartomatosis: an endoscopic ultrasound clinical case

DOI: 10.17235/reed.2019.5894/2018

Editorial

Preventing incomplete and inadequately cleansed capsule endoscopy examinations. Is it possible?

DOI: 10.17235/reed.2018.5820/2018

Original

A descriptive monitoring study of a non-anesthetist sedation quality program

DOI: 10.17235/reed.2018.5763/2018

Letter

Symptomatic exfoliative esophagitis induced by dabigatran

DOI: 10.17235/reed.2018.5747/2018

Original

Effect of conscious sedation with midazolam and fentanyl on the overall quality of colonoscopy: a prospective and randomized study

DOI: 10.17235/reed.2019.5735/2018

Original

Effectiveness and safety of gastrointestinal endoscopy during a specific sedation training program for non-anesthesiologists

DOI: 10.17235/reed.2018.5713/2018

Letter

The sedation issue: accumulating data while failing to advance towards a solution?

DOI: 10.17235/reed.2018.5704/2018

Special Article

The current situation of digestive endoscopy units in the Valencian Community

DOI: 10.17235/reed.2019.5676/2018

Letter

Factors that predict the presence of non-small bowel lesions during capsule endoscopy examinations

DOI: 10.17235/reed.2018.5666/2018

Special Article

Endoscopy and sedation: an inseparable binomial for the gastroenterologist

DOI: 10.17235/reed.2018.5585/2018

Letter

Intramural esophageal dissection. A rare occurrence in pediatric eosinophilic esophagitis

DOI: 10.17235/reed.2018.5577/2018

Letter to the Editor

Me, the intruder: revisited and rethought

DOI: 10.17235/reed.2018.5575/2018

Letter to the Editor

Patients’ perspective on sedation during upper gastrointestinal endoscopy. Systematic use of sedation or systematic prior information?

DOI: 10.17235/reed.2018.5546/2018

Special Article

Basic training in digestive endoscopy for resident physicians in gastroenterology. Recommendations by the Sociedad Española de Endoscopia Digestiva (SEED)

DOI: 10.17235/reed.2018.5545/2018

Letter to the Editor

Sedation assisted by an endoscopist (SAE) for complex endoscopic procedures. Is it time to change the current guidelines?

DOI: 10.17235/reed.2018.5537/2018

Letter to the Editor

Safety of propofol sedation directed by endoscopists: how long should we continue to generate evidence?

DOI: 10.17235/reed.2018.5531/2018

Letter to the Editor

Is the education available to anesthetists adequate to provide sedation in endoscopy units?

DOI: 10.17235/reed.2018.5515/2018

Digestive Diseases Image

Dysphagia and hematemesis caused by an intramural esophageal dissection

DOI: 10.17235/reed.2018.5471/2018

Editorial

Enhancing the current evidence on endoscopist-directed propofol-based sedation

DOI: 10.17235/reed.2018.5502/2017

Original

Efficacy and safety of transoral outlet reduction via endoscopic suturing in patients with weight regain after a surgical Roux-en-Y gastric bypass

DOI: 10.17235/reed.2018.5419/2017

Original

A clinical trial comparing propofol versus propofol plus midazolam in diagnostic endoscopy of patients with a low anesthetic risk

DOI: 10.17235/reed.2018.5289/2017

Original

Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation

DOI: 10.17235/reed.2018.5287/2017

Original

Severe cardiorespiratory complications derived from propofol sedation monitored by an endoscopist

DOI: 10.17235/reed.2018.5282/2017

Original

Quality of sedation with propofol administered by non-anesthetists in a digestive endoscopy unit: the results of a one year experience

DOI: 10.17235/reed.2018.5283/2017

Original

Viability of single balloon enteroscopy performed under endoscopist-directed sedation

DOI: 10.17235/reed.2018.5245/2017

Original

The safety of deep sedation with propofol controlled by the endoscopist in endoscopic retrograde cholangiopancreatography (ERCP): a prospective study in a tertiary hospital

DOI: 10.17235/reed.2018.5262/2017

Letter to the Editor

Real time visualization may be advisable to exclude aspiration in patients undergoing capsule endoscopy examination

DOI: 10.17235/reed.2017.5244/2017

Original

Sedation with propofol in digestive endoscopy administered by gastroenterologists. Experience in a Venezuelan hospital

DOI: 10.17235/reed.2018.5185/2017

Original

Inter and intra-observer concordance for the diagnosis of portal hypertension gastropathy

DOI: 10.17235/reed.2018.5169/2017

Case Report

Hepatocolic fistula managed with a novel Padlock® device for endoscopic closure

DOI: 10.17235/reed.2017.5150/2017

Letter to the Editor

GETTEMO position statement on bariatric endoscopic techniques as a voluntary medicine

DOI: 10.17235/reed.2017.5144/2017

Original

Can we rely on inflammatory biomarkers for the diagnosis and monitoring Crohn’s disease activity?

DOI: 10.17235/reed.2017.5126/2017

Original

Gastroduodenal lesions detected during small bowel capsule endoscopy: incidence, diagnostic and therapeutic impact

DOI: 10.17235/reed.2017.5114/2017

Original

Fecal microbiota transplantation in refractory or recurrent Clostridium difficile infection: a real-life experience in a non-academic center

DOI: 10.17235/reed.2018.5099/2017

Original

Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barrett’s esophagus in Spain

DOI: 10.17235/reed.2017.5087/2017

Original

Capsule endoscopy with PillCamSB2 versus PillCamSB3: has the improvement in technology resulted in a step forward?

DOI: 10.17235/reed.2017.5071/2017

Case Report

Serrated polyposis syndrome associated with long-standing inflammatory bowel disease

DOI: 10.17235/reed.2017.5068/2017

Special Article

Quality indicators in digestive endoscopy: introduction to structure, process, and outcome common indicators

DOI: 10.17235/reed.2017.5035/2017

Letter to the Editor

Propofol sedation Quality and safety. Failure mode and effects analysis.

DOI: 10.17235/reed.2017.4976/2017

Letter to the Editor

In response to the letter by Cabadas and Álvarez-Escudero about the editorial: “Will societies of anesthesiologists partake in the take-off of non-anesthesiologist administration of propofol?”

DOI: 10.17235/reed.2017.4938/2017

Case Report

Laparoscopic transgastric ERCP in bariatric surgery patients: our experience

DOI: 10.17235/reed.2017.4933/2017

Special Article

Spanish consensus document on bariatric endoscopy. Part 2: specific endoscopic treatments

DOI: 10.17235/reed.2019.4922/2017

Letter to the Editor

In response to the editorial: “Will societies of anesthesiologists partake in the take-off of non-anesthesiologist administration of propofol?”

DOI: 10.17235/reed.2017.4909/2017

Digestive Diseases Image

Metastasis of dermatofibrosarcoma diagnosed by capsule endoscopy

DOI: 10.17235/reed.2018.4900/2017

Letter to the Editor

Enough discussions about who should use propofol in gastrointestinal endoscopy

DOI: 10.17235/reed.2017.4901/2017

Original

Clinical manifestations and endoscopic presentations of gastric lymphoma: a multicenter seven year retrospective survey

DOI: 10.17235/reed.2017.4882/2017

Original

Continuous esomeprazole infusion versus bolus administration and second look endoscopy for the prevention of rebleeding in children with a peptic ulcer

DOI: 10.17235/reed.2018.4864/2017

Original

Predictive factors of an incomplete examination and inadequate small-bowel cleanliness during capsule endoscopy

DOI: 10.17235/reed.2018.4834/2017

Editorial

Will societies of anesthesiologists partake in the take-off of non-anesthesiologist administration of propofol?

DOI: 10.17235/reed.2017.4707/2016

Original

A survey-based analysis on endoscopic quality indicators compliance among Spanish endoscopists

DOI: 10.17235/reed.2016.4705/2016

Letter to the Editor

Symptomatic retention of the Agile® patency capsule

DOI: 10.17235/reed.2017.4691/2016

Original

Validation of SPICE, a method to differentiate small bowel submucosal lesions from innocent bulges on capsule endoscopy

DOI: 10.17235/reed.2017.4629/2016

Digestive Diseases Image

Meckel´s diverticulum bleeding detected by capsule endoscopy

Letter to the Editor

Author´s reply to the letter: In response to the editorial “Sedation in endoscopy in 2016: Is it safe sedation with propofol led by the endoscopist in complex situations?”

DOI: 10.17235/reed.2016.4611/2016

Original

Colonic lesions in patients undergoing small bowel capsule endoscopy: incidence, diagnostic and therapeutic impact

DOI: 10.17235/reed.2017.4604/2016

Review

Diagnostic and therapeutic features of small bowel involvement in portal hypertension

DOI: 10.17235/reed.2017.4596/2016

Digestive Diseases Image

Extrinsic esophageal compression by the vertebral body

Special Article

Patient safety under deep sedation for digestive endoscopic procedures

DOI: 10.17235/reed.2016.4572/2016

Letter to the Editor

Ball valve syndrome caused by a giant gastric Vanek’s tumor

DOI: 10.17235/reed.2017.4526/2016

Letter to the Editor

Laparoscopic treatment of hemorrhagic Meckel diverticulum after diagnosis with wireless capsule endoscopy and double-balloon enteroscopy

DOI: 10.17235/reed.2017.4522/2016

Digestive Diseases Image

An unusual cause of Boerhaave´s syndrome in a young patient

Original

The importance of a second opinion in the diagnosis of Barrett’s esophagus: a “real life” study

DOI: 10.17235/reed.2016.4505/2016

Special Article

Spanish Consensus Document on Bariatric Endoscopy. Part 1. General considerations

DOI: 10.17235/reed.2018.4503/2016

Original

Multicenter study on the safety of bariatric endoscopy

DOI: 10.17235/reed.2017.4499/2016

Letter to the Editor

Endoscopic removal of a hashish packet

DOI: 10.17235/reed.2017.4504/2016

Original

The use of a segmental endoscopic score may improve the prediction of clinical outcomes in acute severe ulcerative colitis

DOI: 10.17235/reed.2016.4470/2016

Letter to the Editor

In response to the editorial “Sedation in endoscopy in 2016: Is it safe sedation with propofol led by the endoscopist in complex situations?”

DOI: 10.17235/reed.2016.4471/2016

Original

Antiplatelet agents and/or anticoagulants are not associated with worse outcome following nonvariceal upper gastrointestinal bleeding

DOI: 10.17235/reed.2016.4424/2016

Digestive Diseases Image

Hemolymphangioma as a cause of overt obscure gastrointestinal bleeding: a case report

Original

Therapeutic impact of colon capsule endoscopy with PillCam™ COLON 2 after incomplete standard colonoscopy: a Spanish multicenter study

DOI: 10.17235/reed.2017.4369/2016

Original

Validation of the computed assessment of cleansing score with the Mirocam® system

DOI: 10.17235/reed.2016.4366/2016

Letter to the Editor

Whipple’s disease under the vision of capsule endoscopy

DOI: 10.17235/reed.2016.4362/2016

Letter to the Editor

Asymptomatic bronchial aspiration of capsule endoscope: a significant complication

DOI: 10.17235/reed.2016.4363/2016

Digestive Diseases Image

Signet ring cell carcinoma of the jejunum: an uncommon finding within the reach of capsule endoscopy

Letter to the Editor

Author´s reply: About human taeniasis and Taenia saginata diagnosis by endoscopy

DOI: 10.17235/reed.2016.4339/2016

Original

Fecal calprotectin and C-reactive protein are associated with positive findings in capsule endoscopy in suspected small bowel Crohn’s disease

DOI: 10.17235/reed.2016.4318/2016

Editorial

Sedation for endoscopy in 2016 — Is endoscopist-guided sedation safe in complex situations?

DOI: 10.17235/reed.2016.4383/2016

Letter to the Editor

About human taeniasis and Taenia saginata diagnosis by endoscopy

DOI: 10.17235/reed.2016.4297/2016

Digestive Diseases Image

Jejunal metastasis of renal cell carcinoma

Case Report

Colonic obstruction secondary to sigmoid fecaloma endoscopically resolved with Coca-Cola®

DOI: 10.17235/reed.2017.4209/2016

Original

Endoscopic colostomy with percutaneous colopexy: an animal feasibility study

DOI: 10.17235/reed.2017.4201/2016

Case Report

Pyogenic granuloma in the jejunum successfully removed by single-balloon enteroscopy

DOI: 10.17235/reed.2017.4153/2015

Letter to the Editor

Transanal submucosal endoscopic resection (TASER) by TEO system®

DOI: 10.17235/reed.2016.4154/2015

Original

Prospective study of anxiety in patients undergoing an outpatient colonoscopy

DOI: 10.17235/reed.2016.4104/2015

Editorial

Obscure gastrointestinal bleeding and “obscure” capsule. May we switch on any lights?

DOI: 10.17235/reed.2015.4124/2015

Original

Endoscopic sleeve gastroplasty (the Apollo method): a new approach to obesity management

DOI: 10.17235/reed.2016.3988/2015

Original

Predictive factors of small bowel patency in Crohn's disease patients

DOI: 10.17235/reed.2015.3957/2015

Editorial

Prevention of post-operative recurrence in Crohn´s disease. Are we ready for a treat-to-target strategy?

DOI: 10.17235/reed.2015.3990/2015

Original

Guideline for wireless capsule endoscopy in children and adolescents: A consensus document by the SEGHNP (Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition) and the SEPD (Spanish Society for Digestive Diseases)

DOI: 10.17235/reed.2015.3921/2015

Digestive Diseases Image

A typical but seldom recognized foreign body in the esophagus of a laryngectomized patient

Digestive Diseases Image

Gastric inflammatory fibroid polyp mimicking a gastrointestinal stromal tumour

Original

What is the long-term outcome of a negative capsule endoscopy in patients with obscure gastrointestinal bleeding?

DOI: 10.17235/reed.2015.3900/2015

Original

Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

DOI: 10.17235/reed.2015.3845/2015

Original

Impact of endoscopic monitoring in postoperative Crohn’s disease patients already receiving pharmacological prevention of recurrence

DOI: 10.17235/reed.2015.3836/2015

Original

Incidence, clinical outcomes, and therapeutic approaches of capsule endoscopy-related adverse events in a large study population

DOI: 10.17235/reed.2015.3820/2015

Review

Management of antiplatelet and anticoagulant therapy for endoscopic procedures: Introduction to novel oral anticoagulants

DOI: 10.17235/reed.2016.3811/2015

Original

Fully covered metal stents for the treatment of leaks after gastric and esophageal surgery

DOI: 10.17235/reed.2015.3765/2015

Case Report

Atypical diagnosis diagnosis by endoscopic capsule: Whipple´s disease

DOI: 10.17235/reed.2015.3718/2015

Case Report

Endoscopy as a diagnostic and therapeutic alternative technique of taeniasis

DOI: 10.17235/reed.2015.3585/2014

Digestive Diseases Image

Jejunal plasmablastic lymphoma presenting as obscure overt gastrointestinal bleeding - diagnosis by wireless capsule endoscopy

Citation tools

Pérez-Cuadrado Robles E, González Ramírez A, Lancho Seco Á, Martí Marqués E, Dacal Rivas A, Castro Ortiz E, et all. Safety and risk factors for difficult endoscopist-directed ERCP sedation in daily practice: a hospital-based case-control study. 4206/2016

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Publication history

Received: 18/01/2016

Accepted: 14/02/2016

Online First: 25/02/2016

Published: 29/04/2016

Article revision time: 19 days

Article Online First time: 38 days

Article editing time: 102 days

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