Brief Article
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World J Gastrointest Endosc. Apr 16, 2013; 5(4): 160-164
Published online Apr 16, 2013. doi: 10.4253/wjge.v5.i4.160
Endoscopic retrograde cholangiopancreatography under moderate sedation and factors predicting need for anesthesiologist directed sedation: A county hospital experience
Saurabh Chawla, Ariel Katz, Bashar M Attar, Benjamin Go
Saurabh Chawla, Bashar M Attar, Benjamin Go, Division of Gastroenterology, Department of Medicine, Cook County-John H Stroger Jr Hospital, Chicago, IL 60612, United States
Ariel Katz, Department of Medicine, Cook County-John H Stroger Jr Hospital, Chicago, IL 60612, United States
Bashar M Attar, Department of Medicine, Rush Medical College, Chicago, IL 60612, United States
Author contributions: Chawla S contributed to study design, literature search, data collection, data analysis and manuscript writing; Katz A contributed to study design, data analysis and manuscript writing; Attar BM contributed to study design and manuscript writing; Go B contributed to data collection and manuscript writing.
Correspondence to: Saurabh Chawla, MD, Division of Gastroenterology, Department of Medicine, Cook County-John H Stroger Jr Hospital, Room No. 1435, 14th Floor, 1900 W Polk Street, Chicago, IL 60612, United States. schawla2@gmail.com
Telephone: +1-312-8647955 Fax: +1-312-8647955
Received: July 30, 2012
Revised: December 22, 2012
Accepted: January 5, 2013
Published online: April 16, 2013
Processing time: 260 Days and 16.6 Hours
Abstract

AIM: To evaluate variables associated with failure of gastroenterologist directed moderate sedation (GDS) during endoscopic retrograde cholangiopancreatography (ERCP) and derive a predictive model for use of anesthesiologist directed sedation (ADS) in selected patients.

METHODS: With institutional review board approval, we retrospectively analyzed consecutive records of all patients who underwent ERCPs between July 1, 2009 to October 1, 2011 to identify patient related and procedure related factors which could predict failure of GDS. For patient related factors, we abstracted and analyzed data regarding the age, gender, ethnicity, alcohol and illicit drug use habits. For procedure related factors, we abstracted data regarding initial or repeat procedures, indication for performing ERCP, the interventions performed during ERCP, and the grade d difficulty of cannulation as defined in the American Society for Gastrointestinal Endoscopy guidelines. Our outcome of interest was procedural success. If the procedure was not successful, the reasons for failure of procedures were recorded along with immediate post procedure complications. Multivariate analysis was then performed to define factors associated with failure of GDS and a model constructed to predict requirement of ADS.

RESULTS: Fourteen percent of patients undergoing GDS could not complete the procedure due to intolerance and 2% due to cardiovascular complications. Substance abuse, male gender, black race and alcohol use were significant predictors of failure of GDS on univariate analysis and substance abuse and higher grade of procedure remained significant on multivariate analysis. Using our predictive model where the presence of substance abuse was given 1 point and planned grade of intervention was scored from 1-3, only 12% patients with a score of 1 would require ADS due to failure of GDS, compared to 50% with a score of 3 or higher.

CONCLUSION: We conclude that ERCP under GDS is safe and effective for low grade procedures, and ADS should be judiciously reserved for procedures which have a higher risk of failure with moderate sedation.

Keywords: Cholangiopancreatography; Endoscopic retrograde/methods; Conscious sedation/utilization; Deep sedation/utilization; Adult; Endoscopy