Hey-Long Ching1, Federica Branchi2, David S Sanders1, David Turnbull3, Reena Sidhu1. 1. Department of Gastroenterology, Royal Hallamshire Hospital Sheffield Teaching Hospitals, Sheffield, UK. 2. Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Milano, Italy. 3. Department of Anaesthesia, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
Abstract
OBJECTIVE: Evaluate the safety of propofol-assisted double balloon enteroscopy (DBE) in elderly patients against a younger cohort. DESIGN: Prospective cohort study. SETTING: All patients undergoing DBE over a 30-month period were recruited at our tertiary centre. PATIENTS: 215 procedures in 161 patients were performed. An age cut-off of 65 years and above was used to define those who were elderly. INTERVENTIONS: Patients were subcategorised into four groups: elderly or young undergoing DBE with propofol or conventional sedation (with midazolam±fentanyl). MAIN OUTCOME MEASURES: Patient demographics, comorbidities, procedural data, complications, diagnostic and therapeutic yield were compared. RESULTS: Cardiovascular disease and a higher American Society of Anaethesiologists (ASA) status were more prevalent in elderly patients undergoing DBE with propofol (p<0.05). Common indications for DBE were occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease (elderly vs young: 50.7% vs 42.3%, 17.8% vs 12% and 19.2% vs 26.1%, respectively). Diagnostic yield was higher in elderly compared with young patients (75.3% vs 58.5%, p=0.016). The most common findings in elderly and young patients were angioectasia (30.1% and. 18.3%, respectively) and ulcers (17.8% and 9.2%, respectively), while therapeutic intervention rates were comparable (42.5% vs 32.4%, p=0.18). ASA status did not affect propofol dose (p=0.55) or procedure duration (p=0.31). Tolerance scores were favourable in those receiving propofol compared with conventional sedation (p<0.05). There was no difference in complications between the four groups (p=0.17). CONCLUSION: Compared with young patients, propofol-assisted DBE in the elderly is safe and has a high diagnostic yield.
OBJECTIVE: Evaluate the safety of propofol-assisted double balloon enteroscopy (DBE) in elderly patients against a younger cohort. DESIGN: Prospective cohort study. SETTING: All patients undergoing DBE over a 30-month period were recruited at our tertiary centre. PATIENTS: 215 procedures in 161 patients were performed. An age cut-off of 65 years and above was used to define those who were elderly. INTERVENTIONS: Patients were subcategorised into four groups: elderly or young undergoing DBE with propofol or conventional sedation (with midazolam±fentanyl). MAIN OUTCOME MEASURES: Patient demographics, comorbidities, procedural data, complications, diagnostic and therapeutic yield were compared. RESULTS: Cardiovascular disease and a higher American Society of Anaethesiologists (ASA) status were more prevalent in elderly patients undergoing DBE with propofol (p<0.05). Common indications for DBE were occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease (elderly vs young: 50.7% vs 42.3%, 17.8% vs 12% and 19.2% vs 26.1%, respectively). Diagnostic yield was higher in elderly compared with young patients (75.3% vs 58.5%, p=0.016). The most common findings in elderly and young patients were angioectasia (30.1% and. 18.3%, respectively) and ulcers (17.8% and 9.2%, respectively), while therapeutic intervention rates were comparable (42.5% vs 32.4%, p=0.18). ASA status did not affect propofol dose (p=0.55) or procedure duration (p=0.31). Tolerance scores were favourable in those receiving propofol compared with conventional sedation (p<0.05). There was no difference in complications between the four groups (p=0.17). CONCLUSION: Compared with young patients, propofol-assisted DBE in the elderly is safe and has a high diagnostic yield.
Authors: Eduardo Redondo-Cerezo; Antonio Sánchez-Robaina; Juan Gabriel Martínez Cara; Manuel Ojeda-Hinojosa; Ana Matas-Cobos; Antonio Damián Sánchez Capilla; Mercedes López de Hierro Ruíz; Julio Pleguezuelo-Díaz; Javier de Teresa Journal: Eur J Gastroenterol Hepatol Date: 2012-05 Impact factor: 2.566