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Safety Analysis of Bariatric Patients Undergoing Outpatient Upper Endoscopy with Non-Anesthesia Administered Propofol Sedation

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Abstract

Background

Non-anesthesia administered propofol (NAAP) has been shown to be a safe and effective method of sedation for patients undergoing gastrointestinal endoscopy. Bariatric surgery patients are potentially at a higher risk for sedation-related complications due to co-morbidities including obstructive sleep apnea. The outcomes of NAAP in bariatric patients have not been previously reported.

Methods

In this retrospective cohort study, severely obese patients undergoing pre-surgical outpatient esophagogastroduodenoscopy (EGD) were compared to non-obese control patients (BMI ≤ 25 kg/m2) undergoing diagnostic EGD at our institution from March 2011–September 2015 using our endoscopy database. Patients’ demographics and procedural and recovery data, including any airway interventions, were statistically analyzed.

Results

We included 130 consecutive pre-operative bariatric surgical patients with average BMI 45.8 kg/m2 (range 34–80) and 265 control patients with average BMI 21.9 kg/m2 (range 14–25). The severely obese group had a higher prevalence of sleep apnea (62 vs 8%; p < 0.001), experienced more oxygen desaturations (22 vs 7%; p < 0.001), and received more chin lift maneuvers (20 vs 6%; p < 0.001). Advanced airway interventions were rarely required in either group and were not more frequent in the bariatric group.

Conclusions

With appropriate training of endoscopy personnel, NAAP is a safe method of sedation in severely obese patients undergoing outpatient upper endoscopy.

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Author Contributions

All listed authors have put forth substantial contributions to this manuscript including revisions, final approval, and agreement to be accountable for all aspects of the work.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, 30 N 1900 E SOM 4R118, Salt Lake City, UT, 84132, USA

    Tyler McVay, John C. Fang, Linda Taylor, Alexander Au & Wesley Williams

  2. Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Angela P. Presson & Ragheed Al-Dulaimi

  3. Division of General Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA

    Eric Volckmann & Anna Ibele

Authors
  1. Tyler McVay
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  2. John C. Fang
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  3. Linda Taylor
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  4. Alexander Au
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  5. Wesley Williams
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  6. Angela P. Presson
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  7. Ragheed Al-Dulaimi
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  8. Eric Volckmann
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  9. Anna Ibele
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Corresponding author

Correspondence to John C. Fang.

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Conflict of Interest

Dr. Fang is a consultant to Boston Scientific, Covidien, and Obalon Therapeutics. He is also the owner of Veritract. Dr. McVay, Linda Taylor, Alex Au, Wesley Williams, Angela Presson, Ragheed Al-Dulaimi, Dr. Volckmann, and Dr. Ibele declare that they have no conflict of interest.

Informed Consent

Due to the retrospective design of this study, informed consent was not obtained but was assumed. Patients were not notified.

Human and Animal Rights

Our institutional review board at the University of Utah determined that our study qualified as exempt research, specifically meeting the criteria for non-Federal exemption category 7, which includes research involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, where this information is personally identifiable or coded.

Funding

This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067-02 (formerly 8UL1TR000105 and UL1RR025764).

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McVay, T., Fang, J.C., Taylor, L. et al. Safety Analysis of Bariatric Patients Undergoing Outpatient Upper Endoscopy with Non-Anesthesia Administered Propofol Sedation. OBES SURG 27, 1501–1507 (2017). https://doi.org/10.1007/s11695-016-2478-4

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  • DOI: https://doi.org/10.1007/s11695-016-2478-4

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