Year 2018 / Volume 110 / Number 4
Original
Viability of single balloon enteroscopy performed under endoscopist-directed sedation

240-245

DOI: 10.17235/reed.2018.5245/2017

Leopoldo López Rosés, Beatriz Álvarez, Abel González Ramírez, Alina López Baz, Alexia Fernández López, Sara Alonso, Andrés Dacal, Eva Martí, Gino Albines, Julieta Fernández Molina, Ángel Lancho,

Abstract
Introduction: there is a lot of controversy with regard to who should be responsible for sedation during digestive endoscopy, particularly in advanced procedures that require deep sedation such as enteroscopy. The aim of this study was to evaluate the endoscopist-directed sedation viability during single balloon enteroscopy. Material and method: this was a prospective, observational study of a series of consecutive enteroscopies. The clinical staff included an endoscopist, scrub nurse and a nurse in charge of monitoring and sedative administration. The following parameters were monitored: pulse oximetry, blood pressure (every five minutes), electrocardiogram and respiratory rate. There was continuous supplemental oxygen and CO2 insufflation. The patient was in the left lateral decubitus position and a fluoroscopic control was used. Results: forty-four explorations were performed in 39 patients, 24 were male and 15 female. The median age was 74 (18-89) and the ASA score was I in 12 cases, II in 23 cases and III in nine cases. Comorbidities were present in 68% of cases. The drugs used included propofol in 23 cases, propofol and midazolam in ten cases, propofol/midazolam/fentanyl in two cases, propofol and fentanyl in two cases, and midazolam/fentanyl in seven cases. All procedures were complete. The length of the procedure was 52 minutes (20-120). There were diagnostic findings in 65.9% of cases and therapeutic measures in 47.7%. There were no severe complications and the rate of complications derived from sedation was 22.7%. Conclusion: endoscopist-directed sedation is effective and safe for single balloon enteroscopy. Multi-center and wider studies are needed in order to better assess the efficacy, safety and efficiency of sedation controlled by a non-anesthetist during advanced endoscopy in this field.
Share Button
New comment
Comments
No comments for this article
References
1. Igea F, Casellas JA, González-Huix F, et al. Sedation for gastrointestinal endoscopy. Endoscopy 2014; 46: 720-31.
2. Practice guidelines for sedation and analgesia by non-anesthesiologists. American Society of Anestesthesiologists Task Force on Sedation and Analgesia by Non Anesthesiologists. Anesthesiology 2002; 96:1004-17.
3. Guidelines for the use of deep sedation and anesthesia for GI endoscopy. American Society For Gastrointestinal Endoscopy. Gastrointest Endosc. 2002; 56: 613-16.
4. Training in patient monitoring and sedation and analgesia. Communication from the ASGE Training Committee. Gastrointest Endosc 2007; 66:7-10
5. Sedation and anesthesia in GI endoscopy. ASGE Guideline. Gastrointest Endosc 2008; 68:815-26.
6. Vargo JJ, Cohen LB, Rex DK, et al. Position statement: nonanesthesiologist administration of propofol for GI endoscopy. Gastrointest Endosc 2009; 70:1053 -9.
7. Jain R, Ikenberry SO, Anderson MA, et al. ASGE Standards of Practice Committee. Minimum staffing requirements for the performance of GI endoscopy. Gastrointest Endosc 2010; 72: 469-70.
8. Vargo JJ. DeLegge MH, Feld AD, et al Multisociety sedation curriculum for gastrointestinal endoscopy. Gastrointest Endosc 2012; 76: 1-25.
9. European Curriculum for Sedation Training in Gastrointestinal Endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA). Endoscopy 2013; 45:495-503.
10. Campo R, Brullet E, Junquera F, et al. Sedación en la endoscopia digestiva. Resultados de una encuesta hospitalaria en Cataluña. Gastroenterol Hepatol 2004; 27 (9): 203-7
11. Cubiella Fernández J, Lancho Seco A, Echarri Piudo A, et al. Sedación en las unidades de endoscopia de Galicia. Resultados de la encuesta de la Sociedad Gallega de Patología Digestiva. Rev Esp Enf Dig 2005; 97 (1): 24-37.
12. Baudet JS, Borque P, Borja E, et al. Use of sedation in gastrointestinal endoscopy: a nationwide survey in Spain. Eur J Gastroenterol Hepatol. 2009;21: 882-8.
13. Lucendo AJ, González-Huix F, Tenias JM, et al. Spanish Society of Digestive Diseases, Spanish Society of Digestive Endoscopy, and Spanish Association of Gastroenterology. Gastrointestinal endoscopy sedation and monitoring practices in Spain: a nationwide survey in the year 2014.Endoscopy. 2015 Apr;47(4):383-90.
14. Pérez-Cuadrado E, Más P, Hallal H, et al. Double-balloon enteroscopy: a descriptive study of 50 explorations. Rev Esp Enf Dig 2006; 98 (2): 73-81.
15. Pérez -Cuadrado-Robles E, Esteban-Delgado P, Martínez-Andrés B, et al. Diagnosis agreement between capsule endoscopy and doble-balloon enterosocpy in obscure gastroeintestinal bleeding at a referral center. Rev Esp Enf Dig 2015; 107 (8): 495-500.
16. Riccioni ME, Urgesi R, Cianci R, et al. Current status of device-assisted enteroscopy: Technical matters, indication, limits and complications. World J Gastrointest Endosc 2012; 4 (10): 453-461.
17. ASGE Technology Committee. Technology status evaluation report. Enteroscopy. Gastrointest Endosc 2015; 82 (6): 975-990.
18. ASGE Technology Committee. Enteroscopes. Gastrointest Endosc 2007; 66: 876-80.
19. Mensink PB, Haringsma J, Kucharzik T, et al. Complications of double balloon enteroscopy: a multicentre survey. Endoscopy 2007; 39: 613-5.
20. Gerson LB, Tokar J, Chiorean M, et al. Complications associated with doble balloon enteroscopy at nine US centers. Clin Gastroenterol Hepatol 2009; 7: 1177-82.
21. Treeprasertsuk S, Rerknimitr R, Angsuwatcharakon P, et al. The safety of Propofol infusion compared to midazolam and meperidine intravenous bolus for patients undergoing double balloon enteroscopy. J Med Assoc Thai 2014; 97 (5): 483-9
22. Sethi S, Thaker AM, Cohen J, et al. Monitored anesthesia care without endotracheal intubation is safe and efficacious for single-balloon enteroscopy. Dis Dis Sci 2014; 59 (9): 2184-90.
23. General anesthesia during double balloon enteroscopy. The Hungarian experiences. Orv Hetil 2010; 151 (48): 1976-82 ( Abstract ).
24. Jung M, Hofmann C, Kiesslich R, et al. Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam. Endoscopy 2000; 32: 233-8.
25. Wehrmann T, Kokapick S, Lembcke B, et al. Efficacy and safety of intravenous propofol sedation for routine ERCP: a prospective controlled study. Gastrointest Endosc 1999; 49: 677-83.
26. Vargo JJ, Zuccaro G, Dumot JA, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for ERCP and EUS: a randomized, controlled trial with cost effectiveness analysis. Gastroenterology 2002; 123: 8-16.
27. Goudra BG, Singh PM, Gouda G, et al. Safety of non-anesthesia provider-administered propofol (NAAP) sedation in advanced gastrointestinal endoscpic procedures: comparative meta-analysis of pooled results. Dig Dis Sci 2015; 60 (9): 2612-27.
28. Wadhwa V, Issa D, Garg S, et al. Similar risk of cardiopulmonary adverse events between propofol and traditional anesthesia for gastrointestinal endoscopy: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2017; 15 (2): 194-206.
29. Pérez-Cuadrado-Robles E, González-Ramírez A, Lancho-Seco A, et al. Safety and risk factors for difficult endoscopist-directed ERCP sedation in daily practice: a hospital-based case-control study. Rev Esp Enf Dig 2016; 108: 240-5.
30. Judah JR, Collins D, Gaidos JK, et al. Prospective evaluation of gastroenterologist-guided, nurse-administered standard sedation for spiral deep small bowel enteroscopy. Dig Dis Sci 2010; 55 (9): 2584-91.
31. Aisenberg J. Sedation for Gastrointestinal Endoscopy: New practices, new economics. Am J Gastroenterol 2005; 996-1000.
32. Hassan C, Rex DK, Cooper GS, Benamouzig R. Endoscopist-directed propofol administration versus anesthesiologist assistance for colorectal cancer screening: a cost effectiveness analysis. Endoscopy. 2012 May;44(5):456-64
Related articles

Letter

An unusual cause of abdominal pain in an older female

DOI: 10.17235/reed.2023.9898/2023

Letter

A rare cause of obscure gastrointestinal bleeding

DOI: 10.17235/reed.2022.9156/2022

Review

Advanced therapy by device-assisted enteroscopy

DOI: 10.17235/reed.2020.6971/2020

Editorial

Does it matter how long the small bowel is?

DOI: 10.17235/reed.2020.6980/2020

Special Article

Quality indicators in enteroscopy. Enteroscopy procedure

DOI: 10.17235/reed.2020.6946/2020

Review

Device-assisted enteroscopy training. A rapid review

DOI: 10.17235/reed.2020.6923/2020

Digestive Diseases Image

Enteroscopy in the diagnosis of melanoma metastases

DOI: 10.17235/reed.2020.6820/2019

Citation tools
López Rosés L, Álvarez B, González Ramírez A, López Baz A, Fernández López A, Alonso S, et all. Viability of single balloon enteroscopy performed under endoscopist-directed sedation. 5245/2017


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1144 visits.
This article has been downloaded 153 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 07/09/2017

Accepted: 08/01/2018

Online First: 21/02/2018

Published: 02/04/2018

Article revision time: 115 days

Article Online First time: 167 days

Article editing time: 207 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology