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PTH-031 An Increasing Demand For Enhanced Sedation Endoscopy: A Single Centre Experience
  1. D Joshi1,
  2. M Austin1,
  3. T Bate2,
  4. S Cairns1
  1. 1Digestive Disease Centre, Brighton and Sussex University Hospital, Brighton, UK
  2. 2Department of Anaesthesia, Brighton and Sussex University Hospital, Brighton, UK

Abstract

Introduction The demand for enhanced sedation endoscopy (ESE) appears to be increasing due to increasingly challenging diagnostic and therapeutic procedures. BSG Working Party guidance were issued in 2011.1 Our aim is to describe a single centre experience and highlight the importance of providing such a service.

Methods Retrospective review of all patients undergoing elective ESE at Brighton and Sussex University Hospital (BSUH) from March 2012 to March 2013. Cases were performed in the endoscopy department and in a day surgery theatre. Patients were identified using the Unisoft endoscopy program and day theatre list records. Patient records were reviewed in addition to endoscopy reports. Data collection included patient demographics, indication for procedure, procedure length, success of procedure if previously failed and complications. Data presented as median with range.

Results A total of 89 procedures (OGD x 25 (28%), colonoscopy x 28 (31%), flexible sigmoidoscopy x 2 (2%), ERCP x 24 (27%), OGD/colonoscopy x 10 (9%)) in 79 patients were performed. Median age 53 years (22–75 years), weight 77.5kg (52–126 kg), BMI 26 (22–48), female 60%, ASA 2 (1–4). Indications for ESE included a previously poorly tolerated procedure (38%,n = 34), co-morbidities (24%, n = 21), patient choice (20%, n = 18), previously failed procedure (9%, n = 10) and likely long procedure (7%, n = 6). 80 patients received a combination of propofol/ fentanyl sedation whilst 9 patients required a full general anaesthetic. ESE was delivered by a designated anaesthetist. Median duration of procedure was 35 min (10–65 min). There were no endoscopic related complications. 1 patient developed hypotension requiring intravenous fluids and was admitted for observations overnight and 1 patient developed bronchospasm post extubation requiring intravenous steroid and nebulisers but did not require admission. The use of ESE resulted in the successful completion of all endoscopic procedures.

Conclusion Review of our referrals demonstrates an increasing demand of ESE. Our service initially began as an ad hoc list but now is weekly. ESE appears to be a safe, time efficient and reduces the requirement for repeat procedures.

Reference 1 Guidance for th, UKe use of propofol sedation for adult patients undergoing ERCP and other complex upper GI endoscopy procedures, April 2011. RCoA and BSG working party

Disclosure of Interest None Declared.

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