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  • Type of sedation and the need for unplanned interventions during ERCP: analysis of the clinical outcomes research initiative national endoscopic database (CORI-NED)

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Endoscopy
Original research
Type of sedation and the need for unplanned interventions during ERCP: analysis of the clinical outcomes research initiative national endoscopic database (CORI-NED)
  1. Zachary L Smith1,2,
  2. Katelin B Nickel3,
  3. Margaret A Olsen3,
  4. John J Vargo4,
  5. Vladimir M Kushnir2
  1. 1 Gastroenterology and Liver Disease, University Hospitals, Cleveland, Ohio, USA
  2. 2 Division of Gastroenterology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
  3. 3 Division of Infectious Diseases, Washington University in Saint Louis School of Medicine, Saintt Louis, MO, USA
  4. 4 Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Zachary L Smith, Gastroenterology and Liver Disease, University Hospitals, Cleveland, OH, USA; zachary.smith2{at}uhhospitals.org

Abstract

Background and aims Recent studies suggest that sedation provided by anaesthesia professionals may be less protective against serious adverse events than previously believed, however, data are lacking regarding endoscopic retrograde cholangiopancreatography (ERCP). Using the clinical outcomes research initiative national endoscopic database (CORI-NED), we aimed to assess whether mode of sedation was associated with rates of unplanned interventions (UIs) during ERCP.

Patients and methods All subjects from CORI-NED undergoing ERCP from 2004 to 2014 were identified and stratified into three groups based on the initial mode of anaesthesia: endoscopist-directed sedation (EDS), monitored anaesthesia care without an endotracheal tube (MAC-WET) and general endotracheal anaesthesia (GEA). The primary outcome was UIs. To assess the impact of sedation mode on UIs, multivariable logistic regression models were created adjusting for demographic, physician and procedure-level variables.

Design Population-based study.

Results 26 698 ERCPs were analysed (7588 EDS, 8395 MAC-WET, 10 715 GEA). UIs occurred in 320 ERCPs (1.2%). EDS was associated with a higher risk of UIs compared with sedation administered by an anaesthesia professional (OR 1.86, 95% CI 1.44 to 2.42). Additional factors associated with a higher risk of UIs included ASA class IV compared with class II (OR 3.18, 95% CI 2.00 to 5.06) and ERCPs done in community (OR 1.41, 1.04 to 1.91) and health maintenance organisations (OR 3.75, 2.01 to 6.99) hospitals.

Conclusion EDS is associated with a higher risk of UIs during ERCP compared with sedation administered by an anaesthesia professional. Higher ASA class and procedures performed in non-university hospitals were also associated with a higher risk of UIs. This study suggests that, when available, sedation using an anaesthesia professional should be utilised for ERCP.

  • endoscopic retrograde pancreatography
  • endoscopy
  • anesthesia
  • sedation
  • adverse events

https://doi.org/10.1136/flgastro-2019-101175

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    Footnotes

    • Contributors ZLS: Study concept and design, database acquisition, acquisition of research funds, drafting of manuscript, critical review of manuscript, final approval of manuscript. KN: Database management, statistical analyses, critical review of manuscript, final approval of manuscript. MO: Database management, statistical analyses, critical review of manuscript, final approval of manuscript JV: Study concept and design, critical review of manuscript, final approval of manuscript. VK: Study concept and design, acquisition of research funds, critical review of manuscript, final approval of manuscript.

    • Funding The Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ).

    • Competing interests None declared.

    • Patient consent for publication Not required.

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

    • Data sharing statement No data are available.