OBJECTIVES: While some gastroenterologists provide their own sedation for endoscopic retrograde cholangiopancreatography (ERCP), others utilize anesthesiologists. There is limited information comparing cannulation success and complication rates between these two approaches. Theoretically, anesthesiologist-directed sedation (ADS) may lead to an improved deep cannulation rate by virtue of using deeper and more constant levels of sedation and by removing the minute-by-minute medication management and physiologic monitoring responsibilities from the endoscopy team. AIMS: To compare ERCP deep cannulation success and complications between gastroenterologist-directed sedation (GDS) and ADS. METHODS: All ERCPs completed by senior advanced endoscopists at a tertiary referral center over a 2-year period were reviewed. During the first year, all ERCP sedation was performed with GDS utilizing a narcotic and a benzodiazepine. Due to a change in division policy and practice, during the second year, all ERCP sedation was provided by ADS. Patients with prior papillary interventions were excluded. Demographics, procedure indications, deep cannulation success, sedation provider, and procedural complications were recorded. RESULTS: A total of 367 patients were studied: 178 (48.5%) GDS and 189 (51.5%) ADS. There was no difference in the groups with respect to race, age, and gender. Four patients (2.3%) in the GDS group could not be sedated. There were two deaths, one in each group; one death was due to cholangitis/sepsis and the other was due to post-ERCP pancreatitis. The overall cannulation success rates were similar between the two groups (94.4% vs. 95.2%, P = 0.36). CONCLUSIONS: Deep ductal cannulation rates between GDS and ADS are similar.
OBJECTIVES: While some gastroenterologists provide their own sedation for endoscopic retrograde cholangiopancreatography (ERCP), others utilize anesthesiologists. There is limited information comparing cannulation success and complication rates between these two approaches. Theoretically, anesthesiologist-directed sedation (ADS) may lead to an improved deep cannulation rate by virtue of using deeper and more constant levels of sedation and by removing the minute-by-minute medication management and physiologic monitoring responsibilities from the endoscopy team. AIMS: To compare ERCP deep cannulation success and complications between gastroenterologist-directed sedation (GDS) and ADS. METHODS: All ERCPs completed by senior advanced endoscopists at a tertiary referral center over a 2-year period were reviewed. During the first year, all ERCP sedation was performed with GDS utilizing a narcotic and a benzodiazepine. Due to a change in division policy and practice, during the second year, all ERCP sedation was provided by ADS. Patients with prior papillary interventions were excluded. Demographics, procedure indications, deep cannulation success, sedation provider, and procedural complications were recorded. RESULTS: A total of 367 patients were studied: 178 (48.5%) GDS and 189 (51.5%) ADS. There was no difference in the groups with respect to race, age, and gender. Four patients (2.3%) in the GDS group could not be sedated. There were two deaths, one in each group; one death was due to cholangitis/sepsis and the other was due to post-ERCP pancreatitis. The overall cannulation success rates were similar between the two groups (94.4% vs. 95.2%, P = 0.36). CONCLUSIONS: Deep ductal cannulation rates between GDS and ADS are similar.
Authors: J Shawn Mallery; Todd H Baron; Jason A Dominitz; Jay L Goldstein; William K Hirota; Brian C Jacobson; Jonathan A Leighton; Hareth M Raddawi; John J Varg; J Patrick Waring; Robert D Fanelli; Jo Wheeler-Harbough; Glenn M Eisen; Douglas O Faigel Journal: Gastrointest Endosc Date: 2003-05 Impact factor: 9.427
Authors: Lawrence B Cohen; Julie S Wecsler; John N Gaetano; Ariel A Benson; Kenneth M Miller; Valerie Durkalski; James Aisenberg Journal: Am J Gastroenterol Date: 2006-05 Impact factor: 10.864
Authors: John J Vargo; Gregory Zuccaro; John A Dumot; Kenneth M Shermock; J Brad Morrow; Darwin L Conwell; Patricia A Trolli; Walter G Maurer Journal: Gastroenterology Date: 2002-07 Impact factor: 22.682
Authors: Douglas K Rex; Viju P Deenadayalu; Emely Eid; Thomas F Imperiale; John A Walker; Kuldip Sandhu; Anthony C Clarke; Lybus C Hillman; Akira Horiuchi; Lawrence B Cohen; Ludwig T Heuss; Shajan Peter; Christoph Beglinger; James A Sinnott; Thomas Welton; Magdy Rofail; Iyad Subei; Rodger Sleven; Paul Jordan; John Goff; Patrick D Gerstenberger; Harold Munnings; Martin Tagle; Brian W Sipe; Till Wehrmann; Jack A Di Palma; Kaitlin E Occhipinti; Egidio Barbi; Andrea Riphaus; Stephen T Amann; Gen Tohda; Timothy McClellan; Charles Thueson; John Morse; Nizam Meah Journal: Gastroenterology Date: 2009-06-21 Impact factor: 22.682
Authors: James Buxbaum; Nitzan Roth; Nima Motamedi; Terrance Lee; Paul Leonor; Mark Salem; Dolores Gibbs; John Vargo Journal: Am J Gastroenterol Date: 2016-07-12 Impact factor: 10.864