Endoscopy 2006; 38(5): 461-469
DOI: 10.1055/s-2006-925368
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Current Sedation and Monitoring Practice for Colonoscopy: An International Observational Study (EPAGE)

F.  Froehlich1, 2 , J.  K.  Harris3 , V.  Wietlisbach3 [] , B.  Burnand3 , J.-P.  Vader3 , J.-J.  Gonvers1
  • 1Division of Gastroenterology, Medical Outpatient Department, PMU/CHUV, University of Lausanne, Lausanne, Switzerland
  • 2Gastroenterology Department, University of Basle, Basle, Switzerland
  • 3Institute of Social and Preventative Medicine, University of Lausanne, Lausanne, Switzerland
Further Information

Publication History

Submitted 13 March 2005

Accepted after revision 1 August 2005

Publication Date:
09 May 2006 (online)

Background and Study Aims: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally.
Patients and Methods: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient.
Results: 6004 patients were included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood pressure monitoring in 34 %, and electrocardiography in 24 %. Pulse oximetry was most commonly used for moderately sedated patients, while blood pressure monitoring and electrocardiography were used predominantly for deeply sedated patients. Sedation and monitoring use ranged from 0 % to 100 % between centers. Oxygen desaturation (≤ 85 %) occurred in 5 % of patients, of whom 80 % were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27 % of colonoscopies, and during 85 % of colonoscopies using deep sedation.
Conclusions: Internationally, sedation and monitoring practice during colonoscopy varied widely. Moderate sedation was the most common sedation method used and electronic monitoring was used in three-quarters of patients. Deep sedation tended to be more resource-intensive, implying a greater use of staff and monitoring.

References

  • 1 Eckardt V F, Kanzler G, Schmitt T. et al . Complications and adverse effects of colonoscopy with selective sedation.  Gastrointest Endosc. 1999;  49 560-565
  • 2 Sorbi D, Gostout C J, Henry J. et al . Unsedated small-caliber esophagogastroduodenoscopy (EGD) versus conventional EGD: a comparative study.  Gastroenterology. 1999;  114 1301-1307
  • 3 Ristikankare M, Hartikainen J, Heikkinen M. et al . Is routinely given conscious sedation of benefit during colonoscopy?.  Gastrointest Endosc. 1999;  49 566-572
  • 4 Ristikankare M, Julkunen R, Mattila M. et al . Conscious sedation and cardiorespiratory safety during colonoscopy.  Gastrointest Endosc. 2000;  52 48-54
  • 5 Rex D K, Imperiale T F, Postic G. Patients willing to try colonoscopy without sedation: associated clinical factors and results of a randomized controlled trial.  Gastrointest Endosc. 1999;  49 554-559
  • 6 Mokhashi M S, Hawes R H. Struggling toward easier endoscopy.  Gastrointest Endosc. 1998;  48 432-439
  • 7 Terruzzi V, Meucci G, Radaelli F. et al . Routine versus ”on demand” sedation and analgesia for colonoscopy: a prospective randomized controlled trial.  Gastrointest Endosc. 2001;  54 169-174
  • 8 Sipe B W, Rex D K, Latinovich D. et al . Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists.  Gastrointest Endosc. 2002;  55 815-825
  • 9 Lazzaroni M, Bianchi P orro. Preparation, premedication and surveillance.  Endoscopy. 2003;  35 103-111
  • 10 Heuss L T, Inauen W. The dawning of a new sedative: propofol in gastrointestinal endoscopy.  Digestion. 2004;  69 20-26
  • 11 Hansen J J, Ulmer B J, Rex D K. Technical performance of colonoscopy in patients sedated with nurse-administered propofol.  Am J Gastroenterol. 2004;  99 52-56
  • 12 American Society for Gastrointestinal Endoscopy . Guidelines for the use of deep sedation and anesthesia for GI endoscopy.  Gastrointest Endosc. 2002;  56 613-617
  • 13 Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists.  Gastrointest Endosc. 2001;  53 620-627
  • 14 Huang R, Eisen G M. Efficacy, safety, and limitations in current practice of sedation and analgesia.  Gastrointest Endosc Clin N Am. 2004;  14 269-288
  • 15 Cotton P B, Connor P, McGee D. et al . Colonoscopy: practice variation among 69 hospital-based endoscopists.  Gastrointest Endosc. 2003;  57 352-357
  • 16 Bowles C JA, Leicester R, Romaya C. et al . A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?.  Gut. 2004;  53 277-283
  • 17 Bell G D, Charlton J E. Colonoscopy - is sedation necessary and is there any role for intravenous propofol?.  Endoscopy. 2000;  32 264-267
  • 18 Heuss L T, Froehlich F, Beglinger C. Changing patterns of sedation and monitoring practice during endoscopy: results from a nationwide survey in Switzerland.  Endoscopy. 2005;  37 161-166
  • 19 Ristikankare M KO, Julkunen R JK. Premedication for gastrointestinal endoscopy is a rare practice in Finland: a nationwide survey.  Gastrointest Endosc. 1998;  47 204-207
  • 20 Mulcahy H E, Hennessy E, Connor P. et al . Changing patterns of sedation use for routine out-patient diagnostic gastroscopy between 1989 and 1998.  Aliment Pharmacol Ther. 2001;  15 217-220
  • 21 Froehlich F, Gonvers J J, Fried M. Conscious sedation, clinically relevant complications and monitoring of endoscopy: results of a nationwide survey in Switzerland.  Endoscopy. 1994;  26 231-234
  • 22 Fasoli R, Repaci G, Comin U. et al . A multi-center north Italian prospective survey on some quality parameters in lower gastrointestinal endoscopy.  Dig Liver Dis. 2002;  34 833-841
  • 23 American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists . Practice guidelines for sedation and analgesia by non-anesthesiologists.  Anesthesiology. 2002;  96 1004-1017
  • 24 Gasparovic S, Rustemovic N, Opacic M. et al . Comparison of colonoscopies performed under sedation with propofol or with midazolam or without sedation.  Acta Med Austr. 2003;  30 13-16
  • 25 Keats A. The ASA classification of physical status - a recapitulation.  Anesthesiology. 1978;  49 233-236
  • 26 Pernerger T V. What’s wrong with Bonferroni adjustments.  BMJ. 1998;  316 1236-1238
  • 27 Froehlich F, Thorens J, Schwizer W. et al . Sedation and analgesia for colonoscopy: patient tolerance, pain, and cardiorespiratory parameters.  Gastrointest Endosc. 1997;  45 1-9
  • 28 Heuss L T, Schnieper P, Drewe J. et al . Risk stratification and safe administration of propofol by registered nurses supervised by the gastroenterologist: a prospective observational study of more than 2000 cases.  Gastrointest Endosc. 2003;  57 664-671
  • 29 Heuss L T, Schnieper P, Drewe J. et al . Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients - a prospective, controlled study.  Am J Gastroenterol. 2003;  98 1751-1757
  • 30 Zakko S F, Seifert H A, Gross J B. A comparison of midazolam and diazepam for conscious sedation during colonoscopy in a prospective double-blind study.  Gastrointest Endosc. 1999;  49 684-689

1 Deceased 2004

2 The EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) Study Group consists of: J. Afonso-Debourse (FR), J.-C. Audigier (FR), C. Barthélemy (FR), C. Benoni (SE), J. Bures (CZ), P. Bytzer (DK), S. Chaussade (FR), K. Deinert (DE), R. D’Incà (IT), O. Dumas (FR), V.F. Eckardt (DE), F.-T. Fork (SE), R. Fried (CH), M. Gaudric (FR), L. Gerbaud (FR), S. Gianni (IT), R. Gnauck (DE), H.J. Gyrtrup (DK), J.M. Hansen (DK), R.J. Hilsden (CA), J. Hoch (CZ), R. Keil (CZ), M. Kohut (PL), M. Le Corguillé (FR), P. Matzen (DK), G. Meucci (IT), G. Minoli (IT), P. Moayyedi (GB), H. Neuhaus (DE), A. Nowak (PL), S. O’Mahony (GB), G. Payeras (ES), J.P. Piqueras (ES), J.-F. Rey (FR), J.-P. Rey (CH), S. Rejchrt (CZ), J. Ridpath (GB), T. Romanczyk (PL), M. A. Saez (ES), S. Sahm (DE), S. Sato (SE), B. Saunders (GB), P. Schmidt (DK), B. Schumacher (DE), J. Schwarz (CZ), M. Siroky (CZ), G.C. Sturniolo (IT), D. Swain (GB), E. Toth (SE), and M. Vance (GB)

F. Froehlich, M. D. P. D. 

Division of Gastroenterology · Medical Outpatient Department PMU/CHUV

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Email: florian.froehlich@bluewin.ch