Download PDF
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)

Also available at
    Permissions and Reprints

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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 3 Ristikankare M, Hartikainen J, Heikkinen M. et al . Is routinely given conscious sedation of benefit during colonoscopy?.  Gastrointest Endosc. 1999;  49 566-572
    PubMedGoogle Scholar
  • 4 Ristikankare M, Julkunen R, Mattila M. et al . Conscious sedation and cardiorespiratory safety during colonoscopy.  Gastrointest Endosc. 2000;  52 48-54
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 6 Mokhashi M S, Hawes R H. Struggling toward easier endoscopy.  Gastrointest Endosc. 1998;  48 432-439
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 Lazzaroni M, Bianchi P orro. Preparation, premedication and surveillance.  Endoscopy. 2003;  35 103-111
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Heuss L T, Inauen W. The dawning of a new sedative: propofol in gastrointestinal endoscopy.  Digestion. 2004;  69 20-26
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 American Society for Gastrointestinal Endoscopy . Guidelines for the use of deep sedation and anesthesia for GI endoscopy.  Gastrointest Endosc. 2002;  56 613-617
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 15 Cotton P B, Connor P, McGee D. et al . Colonoscopy: practice variation among 69 hospital-based endoscopists.  Gastrointest Endosc. 2003;  57 352-357
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 17 Bell G D, Charlton J E. Colonoscopy - is sedation necessary and is there any role for intravenous propofol?.  Endoscopy. 2000;  32 264-267
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 25 Keats A. The ASA classification of physical status - a recapitulation.  Anesthesiology. 1978;  49 233-236
    PubMedGoogle Scholar
  • 26 Pernerger T V. What’s wrong with Bonferroni adjustments.  BMJ. 1998;  316 1236-1238
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar

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

Rue du Bugnon 44 · 1011 Lausanne · Switzerland

Fax: +41-32-4662955

Email: florian.froehlich@bluewin.ch