Digestive Diseases and Sciences

, Volume 61, Issue 6, pp 1686–1691 | Cite as

Efficacy and Safety of Propofol-Mediated Sedation for Outpatient Endoscopic Retrograde Cholangiopancreatography (ERCP)

  • Juliana F. Yang
  • Priya Farooq
  • Kate Zwilling
  • Devi Patel
  • Ali A. SiddiquiEmail author
Original Article


Background and Aims

Propofol sedation for endoscopy may result in a rapid and unpredictable progression from deep sedation to general anesthesia, leading to potential complications. We investigated the incidence and predictors of sedation-related adverse events (SAEs) in nonintubated patients who underwent outpatient ERCP procedures with propofol sedation.


We conducted a retrospective study of patients who underwent propofol sedation for ERCP procedures. Patients were sedated using propofol in combination with low-dose opiates. Data collected included patient demographics, American Society of Anesthesiologists (ASAs) physical status, and procedure times. SAE includes hypoxia (pulse oximetry <90 %), hypotension (systolic blood pressure <90 mmHg), and conversation to endotracheal intubation. Factors associated with SAEs were examined by univariate analysis and multivariate regression analysis (MVA).


A total of 3041 patients were evaluated. The median BMI was 25.2 kg/m2, and the median ASA score was 3. The mean (±SD) duration of the procedures was 59 ± 23 min. Hypoxia requiring airway manipulation occurred in 28 % (n = 843) patients and hypotension requiring vasopressors in 0.4 % (n = 12). Forty-nine (1.6 %) patients required endotracheal intubation as a result of food in the stomach. Procedures underwent early termination in 8 (0.3 %) cases due to sedation-related hypotension (n = 5) and refractory laryngospasm (n = 3). Six patients were admitted after the ERCP for aspiration pneumonia as a result of sedation. Patients who developed SAE were older, had a higher mean BMI, and had longer mean procedure durations. On MVA, older age (p = 0.003), female sex (p = 0.001), BMI (p = 0.02), and ASA class ≥3 (p = 0.01) independently predicted SAEs.


Propofol can be used safely and effectively as a sedative agent for patients undergoing ERCPs when administered by trained professionals. Age, female sex, BMI, and ASA class ≥3 are independent predictors of SAEs.


Endoscopic retrograde cholangiopancreatography Propofol Adverse events 



This study was funded entirely through existing intramural funds and salary support.

Author contributions

Juliana F. Yang, MD, Priya Farooq, MD, and Devi Patel, MD, contributed to analysis and interpretation of the data; drafting of the article; and final approval of the article. Ali A. Siddiqui, MD, contributed to conception and design; analysis and interpretation of the data; drafting of the article; and final approval of the article. Kate Zwilling, BSN, analyzed and interpreted the data and finally approved the article.

Compliance with ethical standards

Conflict of interest

The authors attest that they have no commercial associations (e.g., equity ownership or interest, consultancy, patent and licensing agreement, or institutional and corporate associations) that might be a conflict of interest in relation to the submitted manuscript. None of the authors have any potential personal—in addition to financial—conflicts of interest.


  1. 1.
    Jowell PS, Eisen G, Onken J, Bute BP, Ginsberg B. Patient-controlled analgesia for conscious sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled trial. Gastrointest Endosc. 1996;43:490–494.CrossRefPubMedGoogle Scholar
  2. 2.
    Cohen LB, Delegge MH, Aisenberg J, et al. AGA Institute review of endoscopic sedation. Gastroenterology. 2007;133:675–701.CrossRefPubMedGoogle Scholar
  3. 3.
    McCloy R, Nagengast F, Fried M, Rohde H, Froehlich F, Whitwam J. Conscious sedation for endoscopy. Eur J Gastroenterol Hepatol. 1996;8:1233–1240.CrossRefPubMedGoogle Scholar
  4. 4.
    Cote GA, Hovis RM, Ansstas MA, et al. Incidence of sedation-related complications with propofol use during advanced endoscopic procedures. Clin Gastroenterol Hepatol. 2010;8:137–142.CrossRefPubMedGoogle Scholar
  5. 5.
    Wani S, Azar R, Hovis CE, et al. Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures. Gastrointest Endosc. 2011;74:1238–1247.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Jung M, Hofmann C, Kiesslich R, Brackertz A. Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam. Endoscopy. 2000;32:233–238.CrossRefPubMedGoogle Scholar
  7. 7.
    Tringali A, Mutignani M, Milano A, Perri V, Costamagna G. No difference between supine and prone position for ERCP in conscious sedated patients: a prospective randomized study. Endoscopy. 2008;40:93–97.CrossRefPubMedGoogle Scholar
  8. 8.
    Terruzzi V, Radaelli F, Meucci G, Minoli G. Is the supine position as safe and effective as the prone position for endoscopic retrograde cholangiopancreatography? A prospective randomized study. Endoscopy. 2005;37:1211–1214.CrossRefPubMedGoogle Scholar
  9. 9.
    Ferreira LE, Baron TH. Comparison of safety and efficacy of ERCP performed with the patient in supine and prone positions. Gastrointest Endosc. 2008;67:1037–1043.CrossRefPubMedGoogle Scholar
  10. 10.
    Cooper GS, Kou TD, Rex DK. Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med. 2013;173:551–556.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Etzkorn KP, Diab F, Brown RD, et al. Endoscopic retrograde cholangiopancreatography under general anesthesia: indications and results. Gastrointest Endosc. 1998;47:363–367.CrossRefPubMedGoogle Scholar
  12. 12.
    Raymondos K, Panning B, Bachem I, Manns MP, Piepenbrock S, Meier PN. Evaluation of endoscopic retrograde cholangiopancreatography under conscious sedation and general anesthesia. Endoscopy. 2002;34:721–726.CrossRefPubMedGoogle Scholar
  13. 13.
    American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–1017.CrossRefGoogle Scholar
  14. 14.
    VanNatta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol. 2006;101:2209–2217.CrossRefPubMedGoogle Scholar
  15. 15.
    Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013;19:463–481.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Horiuchi A, Nakayama Y, Hidaka N, Ichise Y, Kajiyama M, Tanaka N. Low-dose propofol sedation for diagnostic esophagogastroduodenoscopy: results in 10,662 adults. Am J Gastroenterol. 2009;104:1650–1655.CrossRefPubMedGoogle Scholar
  17. 17.
    Paspatis GA, Manolaraki MM, Vardas E, Theodoropoulou A, Chlouverakis G. Deep sedation for endoscopic retrograde cholangiopancreatography: intravenous propofol alone versus intravenous propofol with oral midazolam premedication. Endoscopy. 2008;40:308–313.CrossRefPubMedGoogle Scholar
  18. 18.
    Chainaki IG, Manolaraki MM, Paspatis GA. Deep sedation for endoscopic retrograde cholangiopacreatography. World J Gastrointest Endosc. 2011;3:34–39.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Berzin TM, Sanaka S, Barnett SR, et al. A prospective assessment of sedation-related adverse events and patient and endoscopist satisfaction in ERCP with anesthesiologist-administered sedation. Gastrointest Endosc. 2011;73:710–717.CrossRefPubMedGoogle Scholar
  20. 20.
    Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients—a prospective, controlled study. Am J Gastroenterol. 2003;98:1751–1757.PubMedGoogle Scholar
  21. 21.
    Wehrmann T, Riphaus A. Sedation with propofol for interventional endoscopic procedures: a risk factor analysis. Scand J Gastroenterol. 2008;43:368–374.CrossRefPubMedGoogle Scholar
  22. 22.
    Vargo JJ, Zuccaro G Jr, Dumot JA, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology. 2002;123:8–16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Juliana F. Yang
    • 1
  • Priya Farooq
    • 2
  • Kate Zwilling
    • 2
  • Devi Patel
    • 2
  • Ali A. Siddiqui
    • 2
    Email author
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of Internal MedicineThomas Jefferson University HospitalPhiladelphiaUSA

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