Published online Jan 21, 2017. doi: 10.3748/wjg.v23.i3.560
Peer-review started: October 7, 2016
First decision: November 9, 2016
Revised: November 15, 2016
Accepted: December 2, 2016
Article in press: December 2, 2016
Published online: January 21, 2017
Processing time: 101 Days and 11.4 Hours
There is compelling evidence to support the quality, cost effectiveness and safety profile of non-anesthesiologist-administered propofol for endoscopic ultrasound (EUS). However in the United Kingdom, it is recommended that the administration and monitoring of propofol sedation for endoscopic procedures should be the responsibility of a dedicated and appropriately trained anaesthetist only. The majority of United Kingdom EUS procedures are performed with opiate and benzodiazepine sedation rather than anaesthetist led propofol lists due to anaesthetist resource availability. We sought to prospectively determine the tolerability and safety of EUS with benzodiazepine and opiate sedation in single United Kingdom centre. Two hundred consecutive patients undergoing either EUS or oesophago-gastroduodenoscopy (OGD) with conscious sedation were prospectively recruited with a 1:1 enrolment ratio. Patients completed questionnaires pre and post procedure detailing anticipated and actual pain experienced on a 1-10 visual analogue scale. Demographics, procedure duration, sedation doses and willingness to repeat the procedure were also recorded. EUS procedures lasted significantly longer than OGDs (15 min vs 6 min, P < 0.0001), however, there was no difference in anticipated pain scores between the groups (EUS 3.37/10 vs OGD 3.47/10, P = 0.46). Pain scores indicated EUS was better tolerated than OGD (1.16/10 vs 1.88/10, P = 0.03) although higher doses of sedation were used for EUS procedures. There were no complications identified in either group. We feel our study demonstrates that the tolerability of EUS with opiate and benzodiazepine sedation is acceptable.
Core tip: Strong evidence exists to support safety and tolerability of non-anaesthesiologist-administered propofol for endoscopic ultrasound (EUS) procedures. United Kingdom guidelines, however, recommend propofol is administered only by anaesthesiologists. Consequently, in the United Kingdom, nearly all EUS procedures are performed with combinations of benzodiazepine and opiate sedation for which little tolerability data exists. This letter shares the experience of a single EUS centre using benzodiazepine and opiate sedation demonstrating it can be safe and the resulting tolerability acceptable.