Passi M, Rahman F, Gurram S, Kumar S, Koh C. Identifying who best tolerates moderate sedation: Results from a national database of gastrointestinal endoscopic outcomes. World J Gastrointest Endosc 2021; 13(4): 97-110 [PMID: 33959232 DOI: 10.4253/wjge.v13.i4.97]
Corresponding Author of This Article
Monica Passi, MD, Academic Fellow, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive Clinical Research Center, 5-2740, Bethesda, MD 20892, United States. mpassi305@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Apr 16, 2021; 13(4): 97-110 Published online Apr 16, 2021. doi: 10.4253/wjge.v13.i4.97
Identifying who best tolerates moderate sedation: Results from a national database of gastrointestinal endoscopic outcomes
Monica Passi, Farial Rahman, Sandeep Gurram, Sheila Kumar, Christopher Koh
Monica Passi, Sheila Kumar, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, United States
Farial Rahman, Christopher Koh, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, United States
Sandeep Gurram, Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, United States
Author contributions: Koh C is the guarantor of this article; Passi M, Rahman F and Koh C designed the study and were involved in devising the study concept; Passi M, Kumar S and Gurram S were involved in the acquisition of the study data; Passi M and Rahman F were involved in the statistical analysis and interpretation of study results; Passi M, Rahman F, Koh C, and Gurram S were involved in the drafting and revision of the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: This study is a retrospective analysis of a publicly available, de-identified data repository (Clinical Outcomes Research Initiative National Endoscopic Database) and therefore is IRB-exempt.
Informed consent statement: This study is a retrospective analysis of a publicly available, de-identified data repository. Informed consent is not indicated.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Monica Passi, MD, Academic Fellow, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive Clinical Research Center, 5-2740, Bethesda, MD 20892, United States. mpassi305@gmail.com
Received: January 6, 2021 Peer-review started: January 6, 2021 First decision: February 11, 2021 Revised: February 19, 2021 Accepted: March 11, 2021 Article in press: March 11, 2021 Published online: April 16, 2021 Processing time: 95 Days and 23.3 Hours
ARTICLE HIGHLIGHTS
Research background
Moderate (conscious) sedation administered by endoscopists provides adequate sedation and analgesia for the majority of American Society of Anesthesia (ASA) class I and II patients undergoing routine gastrointestinal (GI) endoscopy. Deep sedation and general anesthesia are traditionally reserved for patients at higher risk for sedation-related adverse events.
Research motivation
Currently, there are limited society guidelines and insufficient data to aid endoscopists in the selection of the most appropriate sedation method. Rather, this decision is often based on the endoscopist's personal discretion and prior experience.
Research objectives
The study’s main objective was to identify patient and procedure characteristics that may predict better tolerance with moderate sedation for routine GI endoscopy.
Research methods
This was a retrospective cohort study utilizing a nationwide, multi-center repository of endoscopic outcomes. Sedation dose requirements for all adult patients undergoing moderate sedation for esophagogastroduodenoscopy (EGD) and colonoscopy were identified from which patients were stratified into one of two groups based on sedation dose needs (low vs high dose). Anthropometric, procedural, and anesthesia-related data were compared between the two sedation groups, and logistic regression analysis was used to identify factors associated with lower sedation requirements.
Research results
Among 371102 patients included, 63137 patients were stratified into the low dose sedation group and 307965 patients were stratified into the high dose sedation group. Patients undergoing EGDs vs colonoscopies, procedure performed in the inpatient vs outpatient setting, and those performed in ambulatory surgery centers vs endoscopy suites were associated with lower moderate sedation requirements. On further multivariable analysis, factors predictive of tolerance with lower sedation requirements for both EGDs and colonoscopies included female gender, older age (≥ 50 years old), non-White race, Hispanic descent, lower BMI (≤ 25 kg/m2) and higher ASA class.
Research conclusions
We have provided substantive data identifying key demographic and procedure related variables associated with lower sedation requirements during routine GI endoscopy and thereby, improved tolerance with moderate sedation.
Research perspectives
While our findings can help to guide appropriate sedation practices during GI endoscopy, future prospective studies are needed to clarify the effects of patient demographic and procedure related variables on opioid and benzodiazepine response in the procedure setting.
