Abstract
Background
Sedation during endoscopy in cirrhotic patients is typically via moderate sedation, most commonly using a combination of a benzodiazepine (i.e., midazolam) and narcotic (i.e., fentanyl) or with propofol using monitored anesthesia care (MAC). Here, we examined the safety of moderate sedation and MAC in patients with cirrhosis.
Methods
This retrospective cohort study of cirrhotic patients undergoing endoscopy from a large academic medical center between 2010 and 2014 examined extensive clinical data including the following: past history, physical findings, laboratory results, and procedural adverse events. Adverse events were defined a priori and included hypoxia, hypotension, bleeding, and death.
Results
We identified 2618 patients with cirrhosis who underwent endoscopic procedures; the mean age was 56 years, 36% were female, the mean Child–Pugh score was 9.3 (IQR: 8, 11), and Charlson Comorbidity Index score was 3.2 (IQR: 1, 4); 1157 had MAC; and 1461 had moderate sedation. There was no difference in the frequency of adverse events in MAC and moderate sedation groups, with a total of 15 adverse events (7/1157 MAC and 8/1461 moderate sedation). The most common procedure performed was esophagogastroduodenoscopy (EGD, n = 1667) and was associated with 10 adverse events. Overall, adverse events included bradycardia (1), hypoxia (7), bleeding (5), laryngospasm (1), and perforation (1). The frequency was similar for EGD, ERCP, and colonoscopy—each at a rate of 0.6%.
Conclusions
Adverse events in cirrhotic patients undergoing endoscopy appeared to be similar with moderate sedation or MAC, and the frequency was the same for different types of procedures.
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Acknowledgments
The authors would like to thank Dr. Jean Craig for her assistance in helping construct the dataset for this study as well as Dr. Patrick Mauldin for his assistance in performing the statistics for this study.
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Jerome Edelson contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and statistical analysis. Alejandro Suarez performed study design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and statistical analysis. Jingwen Zhang participated in analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Don Rockey contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and study oversight.
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Edelson, J., Suarez, A.L., Zhang, J. et al. Sedation During Endoscopy in Patients with Cirrhosis: Safety and Predictors of Adverse Events. Dig Dis Sci 65, 1258–1265 (2020). https://doi.org/10.1007/s10620-019-05845-7
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DOI: https://doi.org/10.1007/s10620-019-05845-7