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Safety and sedation-associated adverse event reporting among patients undergoing endoscopic cholangiopancreatography: a comparative systematic review and meta-analysis

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Abstract

Background and aim

There is wide variation in choice of sedation and airway management for endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to perform a systematic review and meta-analysis to investigate safety outcomes of deep sedation with monitored anesthesia care (MAC) versus general endotracheal anesthesia (GETA).

Methods

Individualized search strategies were performed in accordance with PRISMA and MOOSE guidelines. This meta-analysis was performed by calculating pooled proportions using random effects models. Measured outcomes included procedure success, all-cause and anesthesia-associated adverse events, and post-procedure recovery time. Heterogeneity was assessed with I2 statistics and publication bias by funnel plot and Egger regression testing.

Results

Five studies (MAC: n = 1284 vs GETA: n = 615) were included. Patients in the GETA group were younger, had higher body mass index (BMI), and higher mean ASA scores (all P < 0.001) with no difference in Mallampati scores (P = 0.923). Procedure success, all-cause adverse events, and anesthesia-associated events were similar between groups [OR 1.16 (95% CI 0.51–2.64); OR 1.16 (95% CI 0.29–4.70); OR 1.33 (95% CI 0.27–6.49), respectively]. MAC resulted in fewer hypotensive episodes [OR 0.32 (95% CI 0.12–0.87], increased hypoxemic events [OR 5.61 (95% CI 1.54–20.37)], and no difference in cardiac arrhythmias [OR 0.48 (95% CI 0.13–1.78)]. Procedure time was decreased for MAC [standard difference − 0.39 (95% CI − 0.78–0.00)] with no difference in recovery time [standard difference − 0.48 (95% CI − 1.04–0.07)].

Conclusions

This study suggests MAC may be a safe alternative to GETA for ERCP; however, MAC may not be appropriate in all patients given an increased risk of hypoxemia.

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Funding

This work was funded, at least in part, by the NIH Grant T32 DK007533-35 (Kelly E. Hathorn).

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Thomas R. McCarty, Kelly E. Hathorn & Christopher C. Thompson

  2. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    David W. Creighton

  3. Department of Internal Medicine, Warren Alpert Medical School of Brown University, Miriam Hospital, Providence, RI, USA

    Mohd Amer AlSamman

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  1. Thomas R. McCarty
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  2. Kelly E. Hathorn
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  4. Mohd Amer AlSamman
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  5. Christopher C. Thompson
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Contributions

Study concept and design—MTR. Paper preparation and statistical analysis—MTR. Critical revisions—MTR, HKE, CDW, AMA, and TCT.

Corresponding author

Correspondence to Christopher C. Thompson.

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Disclosures

Christopher C. Thompson has the following disclosures: Apollo Endosurgery—Consultant/Research Support (Consulting fees/Institutional Research Grants), Aspire Bariatrics – Research Support (Institutional Research Grant), BlueFlame Healthcare Venture Fund—General Partner, Boston Scientific – Consultant (Consulting fees), Covidien/Medtronic—Consultant (Consulting Fees), EnVision Endoscopy (Board Member), Fractyl – Consultant/Advisory Board Member (Consulting Fees), GI Dynamics – Consultant (Consulting Fees)/Research Support (Institutional Research Grant), GI Windows – Ownership interest, Olympus/Spiration—Consultant (Consulting Fees)/Research Support (Equipment Loans), Spatz – Research Support (Institutional Research Grant), USGI Medical—Consultant (Consulting Fees)/Advisory Board Member (Consulting fees)/Research Support (Research Grant). Thomas R. McCarty, Kelly E. Hathorn, David W. Creighton, Mohd Amer AlSamma,has no conflict of interest.

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Institutional IRB approval and written consent was not required given the design of this systematic review and meta-analysis.

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McCarty, T.R., Hathorn, K.E., Creighton, D.W. et al. Safety and sedation-associated adverse event reporting among patients undergoing endoscopic cholangiopancreatography: a comparative systematic review and meta-analysis. Surg Endosc 35, 6977–6989 (2021). https://doi.org/10.1007/s00464-020-08210-2

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  • DOI: https://doi.org/10.1007/s00464-020-08210-2

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