MONOCENTRIC ITALIAN EXPERIENCE OF NON-ANESTHESIOLOGIST SEDATION ACCORDING TO ESGE RECOMMENDATION ON STAFF TRAINING AND PATIENT MANAGEMENT

Aims Several scientific societies have approved the non-anaesthesiologist sedation (NAS) in GI endoscopy, considering it a safe procedure when administered by adequately trained personnel. No data are available on NAS safety after implementation in a digestive endoscopy service of the ESGE-ESGENA training program. This study is a picture of our real-life experience of NAS (also using propofol), after the implementation of that European training program. Primary endpoint was the occurrence of adverse events (AE). Secondary endpoints were EGDS and colonoscopy performances, evaluation of drugs dosages.

Methods From January 2017 to June 2018, data of all consecutive endoscopic procedures performed in our Digestive Endoscopy Unit were collected using an electronic-reporting system. Inclusion criteria were age ≥ 18 years and eligibility to NAS.

Results The entire staff (physicians and nurses) performed the ESGE-ESGENA recommended sedation training course. Of 12.132 patients, 10755 patients fulfilled inclusion criteria and were divided into 2 groups: midazolam + fentanyl group (n. 2284, 21.2%) and PBS (propofol-based sedation) group (n. 8471, 78.8%). No major adverse events (AE) occurred in both groups, even in elderly people (≥ 80 years). All EGDS were complete. On a total of 6853 colonoscopies, total cecal intubation rate was 96.8%, significantly higher in the PBS group (97.5% vs 94.0%, p < 0.0001). Midazolam mean dosage was significantly lower in the PBS group, both for EGDS and colonoscopy (p < 0.0001). Fentanyl mean dosage was significantly lower in the PBS group during colonoscopy (p < 0.0001).

Conclusions This Italian monocentric non-academic experience supports the efficacy and safety of NAS, when specific ESGE-ESGENA training program became part of staff curriculum. Moreover, PBS seems to improve performance and quality of endoscopic procedures.