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Research
Paradigm shift: should the elderly undergo propofol sedation for DBE? A prospective cohort study
  1. Hey-Long Ching1,
  2. Federica Branchi2,
  3. David S Sanders1,
  4. David Turnbull3,
  5. Reena Sidhu1
  1. 1Department of Gastroenterology, Royal Hallamshire Hospital Sheffield Teaching Hospitals, Sheffield, UK
  2. 2Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Milano, Italy
  3. 3Department of Anaesthesia, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
  1. Correspondence to Dr Hey-Long Ching, Clinical Research Fellow, Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, S10 2JF, United Kingdom; hey-long.ching{at}sth.nhs.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.

  • double balloon enteroscopy
  • DBE
  • device assisted enteroscopy
  • advanced endoscopy
  • elderly
  • propofol
  • sedation
  • anaesthesia
  • safety

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Footnotes

  • Contributors RS designed the study, assisted with interpretation of results and critically appraised the manuscript. H-LC performed data collection, led the analysis of data and drafted the manuscript. FB, DSS and DT performed data collection and critically appraised the manuscript. All authors approved the final manuscript. H-LC is guarantor.

  • Competing interests None declared.

  • Ethics approval The study was registered and approved as service evaluation with the Clinical Effectiveness Unit, Sheffield Teaching Hospitals NHS Foundation Trust (registration number 7073).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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