Sequence of same-day upper and lower gastrointestinal endoscopy does not affect total procedure' time or medication use: A randomized trial

Muhammad B Hammami, Kavya M Reddy, Pratik Pandit, Elie J Chahla, Nabeel Koro, Matthew J Schuelke, Christine Hachem, Muhammad B Hammami, Kavya M Reddy, Pratik Pandit, Elie J Chahla, Nabeel Koro, Matthew J Schuelke, Christine Hachem

Abstract

Background and aim: Same-day double upper and lower gastrointestinal endoscopy is frequently performed due to overlapping indications. However, it is unclear whether an upper-lower (U-L) or lower-upper (L-U) sequence is optimal. We analyzed the effect of sequence on total procedure time and sedation use.

Methods: A total of 100 patients scheduled for same-day double endoscopy were randomized to the U-L or L-U sequence arm. Primary outcomes, mean total procedure time, and sedative dosages were compared using a t-test. We also explored associations of the primary outcomes with patient-related and procedure-related factors.

Results: Comparing U-L and L-U sequences, mean total procedure time was 41.9 (16.2) versus 43.0 (14.5) min (P = 0.73), diphenhydramine dose 5.5 (15.4) versus 4.5 (14.0) mg (P = 0.74), fentanyl dose 71.5 (119.3) versus 77.6 (164.02) μg (P = 0.83), midazolam dose 1.6 (2.5) versus 1.4 (2.7) mg (P = 0.69), and propofol dose 437.4 (351.4) versus 444.5 (256.0) mg (P = 0.91), respectively. Total procedure and upper endoscopy times were significantly longer with trainee presence (P = 0.0002) and shorter with conscious sedation (P = 0.003). Upper endoscopy time was longer with higher body mass index (P = 0.001), and lower endoscopy time was longer in patients with cirrhosis or chronic kidney disease (P = 0.002 and 0.009, respectively). Time between procedures was significantly longer in the L-U sequence (7.4 [2.9] vs 5.3 [1.1] min, [P < 0.001]). The study had 80% power to detect an 8 min difference in total procedure time.

Conclusions: The sequence of same-day double gastrointestinal endoscopy does not affect total procedure time or medication use. Longer total procedure and upper endoscopy times were associated with trainee presence and use of conscious sedation.

Keywords: colonoscopy; digestive system endoscopy; endoscopy.

© 2019 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

References

    1. Zuckerman G, Benitez J. A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding. Am. J. Gastroenterol. 1992; 87: 62–6.
    1. Urquhart J, Eisen G, Faigel DO, Mattek N, Holub J, Lieberman DA. A closer look at same day bidirectional endoscopy. Gastrointest. Endosc. 2009; 69: 271–7.
    1. Lucendo AJ, Arias Á, González‐Castillo S et al Same‐day bidirectional endoscopy with nonanesthesiologist administration of propofol: safety and cost‐effectiveness compared with separated exams. Eur. J. Gastroenterol. Hepatol. 2014; 26: 301–8.
    1. Triadafilopoulos G, Aslan A. Same‐day upper and lower inpatient endoscopy: a trend for the future. Am. J. Gastroenterol. 1991; 86: 952–5.
    1. Cho JH, Kim JH, Lee YC, Song SY, Lee SK. Comparison of procedural sequences in same‐day bidirectional endoscopy without benzodiazepine and propofol sedation: starting at the bottom or the top. J. Gastroenterol. Hepatol. 2010; 25: 899–904.
    1. Chen SW, Cheng CL, Liu NJ et al Optimal procedural sequence for same‐day bidirectional endoscopy with moderate sedation: a prospective randomized study. J. Gastroenterol. Hepatol. 2018; 33: 689–95.
    1. Hsieh YH, Lin HJ, Tseng KC. Which should go first during same‐day bidirectional endosocopy with propofol sedation? J. Gastroenterol. Hepatol. 2011; 26: 1559–64.
    1. Tang JH, Cheng CL, Kuo YL, Tsui YN. Paired comparison of procedural sequence in same‐day bidirectional endoscopy with moderate sedation and carbon dioxide insufflation: a prospective observational study. Saudi J. Gastroenterol. 2016; 22: 360–5.
    1. Carter D, Lahat A, Papageorgiou NP, Goldstein S, Eliakim R, Bardan E. Comparison of procedural sequence in same‐day consecutive bidirectional endoscopy using moderate sedation: a prospective randomized study. J. Clin. Gastroenterol. 2014; 48: 236–40.
    1. Choi JS, Youn YH, Lee SK et al Which should go first during same‐day upper and lower gastrointestinal endoscopy? A randomized prospective study focusing on colonoscopy performance. Surg. Endosc. 2013; 27: 2209–15.
    1. Kurien M, Din S, Dear KL, Elphick DA. Same day bidirectional endoscopy ‐ does the procedural order matter? J. Gastrointestin. Liver Dis. 2012; 21: 328.
    1. Cao Y, Yang J, Li J et al Comparison of procedural sequences in same‐day painless bidirectional endoscopy: single‐center, prospective, randomized study. Dig. Endosc. 2017; 29: 330–7.

Source: PubMed

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