Original Article: Clinical Endoscopy
A national study of cardiopulmonary unplanned events after GI endoscopy

https://doi.org/10.1016/j.gie.2006.12.040Get rights and content

Background

Cardiopulmonary unplanned events (CUE) related to conscious sedation constitute a major proportion of GI endoscopy–associated complications.

Objectives

Our purpose was to study the incidence of CUE during GI endoscopy and to determine factors that may predict CUE.

Design

Retrospective CORI (Clinical Outcomes Research Initiative) database review.

Patients

Undergoing GI endoscopy under conscious sedation.

Main Outcome Measurement

CUE associated with GI endoscopy.

Results

Data on 324,737 unique procedures (EGD, 140,692; colonoscopy, 174,255; ERCP, 6092; and EUS, 3698) performed with the patient under conscious sedation were analyzed. Unplanned events were reported in 1.4% of procedures; 0.9% were associated with CUE. Rates of CUE with EGD, colonoscopy, ERCP, and EUS were 0.6%, 1.1%, 2.1%, and 0.9%, respectively. Multiple logistic regression revealed patient age (odds ratio [OR] 1.02, 95% CI 1.01-1.02) and ASA class were significant predictors of CUE (OR compared with ASA I: ASA II 1.05, 95% CI 0.95-1.16; ASA III 1.8, 95% CI 1.6-2.0, ASA IV 3.2, 95% CI 2.5-4.1, ASA V 7.5; 95% CI 3.2-17.6). Inpatient procedures were associated with higher CUE (OR 1.5, 95% CI 1.3-1.7). Compared with universities, nonuniversity sites (OR 1.2, 95% CI 1.1-1.4) and Veterans Administration Medical Centers (OR 1.4, 95% CI 1.2-1.5) had significantly higher CUE. Use of supplemental oxygen during a procedure was associated with significantly more CUE (OR 1.2, 95% CI 1.1-1.3). Involvement of a trainee with a procedure was also associated with higher CUE (OR 1.3, 95% CI 1.1-1.4).

Limitations

Retrospective review of data entered voluntarily by endoscopists not trained on CORI data entry.

Conclusions

During GI endoscopy with conscious sedation, patient's age, higher ASA grade, inpatient status, trainee participation, and routine use of oxygen are associated with a higher incidence of CUE.

Section snippets

Patients and methods

Data on GI endoscopies from April 1997 to March 2002 reported in the CORI database were queried. The data on EUS were available from February 1998. Flexible sigmoidoscopies, unsedated endoscopies, and endoscopies performed under propofol or general anesthesia were excluded from the analysis. Data on patient demographics and American Society of Anesthesia (ASA) class, type of procedure, type and dose of conscious sedation and reversal medications, and use of routine supplemental oxygen during

Results

Between April 1997 and March 2002, 335,249 endoscopic procedures, 991 (0.3%) without sedation, 324,737 (96.9%) with conscious sedation, and 9532 (2.8%) under general anesthesia, were reported in the CORI database. Unplanned events were reported in 4477 (1.4%) of the procedures performed with conscious sedation, of which 3011 (0.9%) were cardiopulmonary unplanned events. Complete data on analyzed variables were available in 247,889 (76%) procedures, and these were included in the multiple

Discussion

Conscious sedation is associated with greater patient tolerance and satisfaction with GI endoscopy; hence most endoscopies are performed under conscious sedation.9, 10 Because of central cardiorespiratory depression, conscious sedation is associated with a small but finite risk of cardiopulmonary unplanned events, which remain the leading cause of morbidity and mortality with GI endoscopy.1, 2, 3, 4, 5, 6, 7 The incidence of and factors responsible for cardiopulmonary unplanned events in

References (22)

  • R. McCloy

    Asleep on the job: sedation and monitoring during endoscopy

    Scand J Gastroenterol

    (1992)
  • Cited by (336)

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    Presented at the ASGE plenary session, Digestive Disease Week 2002, San Francisco, California, USA.

    The data in this manuscript were obtained from the Clinical Outcomes Research Initiative National Endoscopy Database (CORI-NED) with support from the National Institutes of Health NIDDK grant No. U01-DK57132-01.

    See CME section; p. 125.

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