Successful completion of upper gastrointestinal endoscopy: A retrospective comparative study on patients who had endoscopy with sedation and without sedation

Abstract

ABSTRACT Introduction: Sedation of patients before esophagoduodenoscopy (EGD) is common practice. It is expensive, increases the time required to perform the procedure and increases risks of complications. We have set out to determine if sedation improves EGD completion rates. Methods: 1539 EGDs were performed in the UK by an experienced endoscopist. The age, sex, premedication and completion data made at each procedure were recorded. A completed procedure was defined by the ability of the endoscopist to reach the second part of the duodenum. We measured the difference in the completion rates of EGD between sedated and non sedated patients. Results: The completion rate for all procedures was 96.6%. 97.8% of procedures were complete in non sedated patients vs. 94.7% in sedated patients (p = 0.001). Male patients were more likely to have the EGD without sedation, as were those over the age of 65. There were no significant differences in the completion rates of EGD between patients who received IV sedation plus topical local anesthesia and those who received IV sedation alone. Conclusion: The effect of sedation on EGD completion rates is previously undocumented. In order to reduce numbers of failed procedures and prevent exposing patients to the risks of sedation, we suggest these patients should be targeted for more intense pre-procedure counseling. Adequate explanation and reassurance may reduce numbers of patients who request IV sedation by reducing anxiety and increasing expectations of comfort. Reducing numbers of sedated patients may also result in a faster, more cost effective service. (J Dig Endosc 2013;4(2):33-38)