Editorial: Endoscopic Sedation: Who, Which, When?

The costs of medical care are rising and media has focused attention on the costs of colonoscopy as a potential cause. A major component of procedural costs is the sedation, which is a combination of the drugs used and who administers them. An analysis of advanced endoscopic procedures revealed that the rate of sedation failure was significantly lower among patients administered sedation by anesthesia compared with patients who received moderate sedation administered by endoscopy staff. The authors argue that all endoscopic retrograde cholangiopancreatography (ERCP) should be performed with anesthesia-administered sedation. Balancing this argument, another paper reported a significant increase in the proportion of endoscopic procedures performed with anesthesia assistance with the majority being performed in low-risk patients. Propofol and who administers the drug will be a key issue in managing health-care costs.