CONSCIOUS SEDATION FOR ENDOSCOPIC ULTRASONOGRAPHY WITH FINE NEEDLE ASPIRATION IS EFFECTIVE AND WELL-TOLERATED

Aims:

Endoscopic ultrasonography (EUS) is an important procedure for the diagnosis of pancreatic disorders allowing fine-needle aspiration (FNA). We aimed to investigate the efficacy and tolerance of the procedure in patients who received only conscious sedation.

Methods:

Patients who underwent EUS for diagnostic evaluation and tissue acquisition for pancreatic disorders were prospectively evaluated for the efficacy and tolerance of sedation. Sedation used included combination of midazolam and fentanyl to achieve relaxation or mild sleep, but keeping patient responsive to orders and able to open his eyes when instructed to do so. Oxygen saturation, blood pressure and pulse rare was constantly monitored during procedure and until complete recovery of patients.

Results:

In total 80 subsequent patients who underwent evaluation of a pancreatic solid or cystic lesion were studied (45 males, median age 72, range 42 – 88 years). The patients received midazolam at a median dose of 3.2 mg (range 1 – 8 mg) and fentanyl at a median dose of 50 mcg (range 25 – 150 mcg). Procedure was tolerated rather well in all patients and was abandoned after a less than expected number of needle passes in only four patients. When interviewed, 52 patients found procedure comfortable, 14 patients well-tolerable, 14 patients uncomfortable. Pancreatic evaluation achieved in all patients and tissue acquisition achieved in 74. In the remaining patients procedure had to be repeated (in 4) or surgical biopsy was preferred (in 2). The median duration of the procedure was 32 minutes (range 18 – 72 minutes). However, physicians performing procedure found that deep sedation would be preferable for at least half of the patients.

Conclusions:

EUS-FNA can safely be performed with conscious sedation in the majority of patients, if there is no availability of deep sedation. This may not be the case in patients who cannot be easily sedated of if patient has to undergo more complex procedure.