BMC Gastroenterology (Sep 2023)

The efficacy of non-anesthesiologist-administered propofol sedation with a target-controlled infusion system during double-balloon endoscopic retrograde cholangiopancreatography

  • Kazuya Miyamoto,
  • Kazuyuki Matsumoto,
  • Taisuke Obata,
  • Ryosuke Sato,
  • Akihiro Matsumi,
  • Kosaku Morimoto,
  • Taiji Ogawa,
  • Hiroyuki Terasawa,
  • Yuki Fujii,
  • Tatsuhiro Yamazaki,
  • Daisuke Uchida,
  • Shigeru Horiguchi,
  • Koichiro Tsutsumi,
  • Hironari Kato,
  • Motoyuki Otsuka

DOI
https://doi.org/10.1186/s12876-023-02936-8
Journal volume & issue
Vol. 23, no. 1
pp. 1 – 9

Abstract

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Abstract Background The sedation method used during double-balloon endoscopic retrograde cholangiopancreatography (DB-ERCP) differs among countries and/or facilities, and there is no established method. This study aimed to evaluate the efficacy of non-anesthesiologist-administered propofol (NAAP) sedation using a target-controlled infusion (TCI) system during DB-ERCP. Methods This retrospective study was conducted between May 2017 and December 2020 at an academic center. One hundred and fifty-six consecutive patients who underwent DB-ERCP were sedated by gastroenterologists using diazepam (n = 77) or propofol with a TCI system (n = 79), depending on the period. The primary endpoint was a comparison of poor sedation rates between the two groups. Poor sedation was defined as a condition requiring the use of other sedative agents or discontinuation of the procedure. Secondary endpoints were sedation-related adverse events and risk factors for poor sedation. Results Poor sedation occurred significantly more often in the diazepam sedation group (diazepam sedation, n = 12 [16%] vs. propofol sedation, n = 1 [1%]; P = 0.001). Vigorous body movements (3 or 4) (diazepam sedation, n = 40 [52%] vs. propofol sedation, n = 28 [35%]; P = 0.038) and hypoxemia (< 85%) (diazepam sedation, n = 7 [9%] vs. propofol sedation, n = 1 [1%]; P = 0.027) occurred significantly more often in the diazepam sedation group. In the multivariate analysis, age < 70 years old (OR, 10.26; 95% CI, 1.57–66.98; P = 0.015), BMI ≥ 25 kg/m2 (OR, 11.96; 95% CI, 1.67–85.69; P = 0.014), and propofol sedation (OR, 0.06; 95% CI, 0.01–0.58; P = 0.015) were associated factors for poor sedation. Conclusions NAAP sedation with the TCI system during DB-ERCP was safer and more effective than diazepam sedation.

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