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Su1512 A Nationwide Web-Based Survey of Endoscopic Sedation and Concomitant Monitoring Practices in Korea
Abstracts
(average 96 mcg). Average procedure length was 44 minutes. Average outpatient recovery was 119 minutes.Four adverse events were reported, including 1 case of hypotension and 3 cases of bradycardia. In all cases the adverse event resolved after suspension of DXM. In 3 cases, DCS was restarted without further incident. In the 4th case hypotension persisted, and the procedure was completed with fentanyl and midazolam only. In 2 other cases DCS was abandoned for MAC after the patients became too agitated to continue.The wholesale cost of DXM was $66.00 per procedure. The wholesale cost of propofol averaged $8.00 to $16.00 per procedure. There was no difference in the cost of midazolam and fentanyl when comparing DCS to MAC. The typical anesthesiologist charge was estimated to be $900.00 per case. Conclusion: Our data suggest that use of DCS was not associated with any significant adverse events. Endoscopists were uniformly satisfied with DCS.In this study the use of DCS was safe, effective and less costly than MAC. Further study is warranted.
Su1512 A Nationwide Web-Based Survey of Endoscopic Sedation and Concomitant Monitoring Practices in Korea Chang Kyun Lee*1,2, Eun Sun Kim3,2, Seok Ho Dong1,2, Sung-Hoon Moon4,2, Hong Jun Park5,2, Dong-Hoon Yang6,2, Tae Hoon Lee7,2, Sang Kil Lee8,2, Jong Jin Hyun3,2 1 Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea (the Republic of); 2the Korean Society of Gastrointestinal Endoscopy (KSGE) Task Force on Endoscopic Sedation, Seoul, Korea (the Republic of); 3internal medicine, Korea University College of Medicine, Seoul, Korea (the Republic of); 4Internal medicine, Hallym University College of Medicine, Anyang, Korea (the Republic of); 5Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of); 6University of Ulsan College of Medicine, Seoul, Korea (the Republic of); 7 Soonchunhyang University College of Medicine, Cheonan, Korea (the Republic of); 8Yonsei University College of Medicine, Seoul, Korea (the Republic of) Background: Wide variation exists in the use of endoscopic sedation and concomitant monitoring practices worldwide. Aims: This study explored endoscopists’ practices of sedation and monitoring in Korea. Methods: A 5-section, 35-item anonymous questionnaire was developed by the Korean Society of Gastrointestinal Endoscopy (KSGE) Task Force on Endoscopic Sedation. All members of the KSGE were invited to complete a Web-based self-reported questionnaire during the survey period (August 2014), and all data were transferred via the Web to a central database. Results: In total, 1332 of the 5860 invited KSGE members completed the survey, representing an overall response rate of 22.7%. The mean age of respondents was 43.4 years; 80.2% were men, and 82.4% were gastroenterologists. Forty-six percent of respondents practiced at private clinics, 26.2% practiced at nonacademic community hospitals, and 27.9% practiced at academic teaching hospitals. A vast majority of respondents (98.9%, 1318/1332) routinely performed procedural sedation for diagnostic esophagogastroduodenoscopy (99.1%) and colonoscopy (91.4%); the dominant method was midazolam alone for esophagogastroduodenoscopy (37.0%) and a combination of midazolam and propofol for colonoscopy (33.8%). Sixty-three percent of respondents (830/1318) routinely used propofol with a high physician satisfaction rating: 91.1% scored this technique as R7 points on a 10-point visual analog scale. Propofol was exclusively administered by non-anesthesiologists (99.8%). Community practitioners, gastroenterologists, or endoscopists with !10 years of practice experience were more likely to use propofol than were practitioners at academic hospitals, non-gastroenterologists, or endoscopists with O10 years of practice experience (67.7% vs. 50.9%, 65.8% vs. 49.1%, and 71.8% vs. 52.7%, respectively; all P ! 0.001). The fear of cardiopulmonary side effects was the most common reason cited for not currently using propofol (50.0%, 244/488). The majority of respondents (94.1%) routinely monitored patients using pulse oximetry, and 42.5% routinely administered supplemental oxygen. However, 38.3% of respondents rarely or never used the American Society of Anesthesiologists physical status classification for preprocedural assessment. A substantial proportion of respondents (8.9%) practiced sedation without targeted training for endoscopic sedation, and 27.4% practiced without sedation administration and monitoring protocols. Conclusions: Non-anesthesiologist-administered propofol sedation is becoming a standard practice during gastrointestinal endoscopy in Korea. The results of this survey suggest the need to address many important issues impacting the quality improvement in patient care, the development of appropriate training programs and, potentially, policy-making.
Su1513 Lidocaine Sprayed-on the Endoscope Can Improve the Tolerance During Upper Gastrointestinal Endoscopy? Byung Hyo Cha* Gastroenterology disease center, Che-ju Halla General Hospital, Che-ju, Korea (the Republic of) Backgrounds and aims: Topical pharyngeal anesthesia has been the standard preparation for reducing the discomfort during upper gastrointestinal endoscopy
www.giejournal.org
(UGIE). But it is not clear whether this method effective in regard to the tolerance of procedure. The aim of this study is to assess the efficacies of the added lidocaine spray on the tip of endoscope in improving patient tolerance. Methods: All the patients underwent upper gastrointestinal endoscopy were consecutively enrolled and assigned to case group with additional 2 puffs of the 10% lidocaine spray on the tip of endoscope before intubation or control group without additional spray. During the endoscopy, the main outcomes including frequency of retching and belching were measured by independent assistants. Results: Among 497 eligible patients, 262 were assigned to case group and 235 to control. In univariated and multivariated analysis, there was significant difference between two groups in terms of belching (case vs. control, OR Z 0.15, 95% CI Z 0.09 - 0.24, p ! 0.01) and retching (case vs. control, OR Z 0.22, 95% CI Z 0.15 - 0.34, p Z 0.01). Elderly showed less probability of belching events (age, OR Z 0.96, 95% CI Z 0.94 - 0.98, p! 0.01), female sex was found as another predictive value of the presence of belching (female vs. male, OR Z 2.16, 95% CI Z 1.40 - 3.33, p Z 0.01). The sedation and patients with GERD were revealed as the factors correlated to the presence of retching (sedated vs. nonsedated, OR Z 0.39, 95% CI Z 0.25-0.61, p Z 0.01; GERD vs. none, OR Z 1.48, 95% CI Z 1.00 - 2.21, p Z 0.06). Conclusions: The new methods adding lidocaine spray on the endoscope can improve the patient tolerance during UGIE.
Multivariated analysis of the factors contributing Two primary outcomes of endoscopy tolerance using Logistic regression model. (N[497) Presence of belching
Unadjusted N
% of belching
OR
Adjusted 95% CI
p Value
Age
OR
95% CI
0.96
0.940.98 1.403.33
p Value ! 0.01 0.01
Sex
Female
186
59.6
1.21
1.051.39
0.006
2.16
Groups
Male 1Case
126 120
40.4 46.1
0.55
0.480.69
! 0.01
0.15
0.090.24
! 0.01
Control Yes
192 261
83.1 83.7
0.98
0.821.71
0.82
0.81
0.451.45
0.48
No Yes
51 99
16.3 36.9
1.01
0.881.17
0.87
1.16
0.741.81
0.53
No
212
63.1 1.07
Yes
132
42.9
1.04
0.911.19
0.56
0.971.19 0.811.89
No
176
57.1
N
% of Retching
95% CI
p Value
Prior Endoscopy Experiance Sedation
Endoscopy Time GERD
Presence of Retching
Unadjusted OR
Age
1.22
Adjusted OR 0.22
95% CI 0.150.34 0.841.91
0.19 0.34
p Value ! 0.01 0.26
Sex
Female
167
56.2
1.05
0.911.22
0.59
1.27
Groups
Male 1Case
130 119
43.8 40.0
0.59
0.510.69
! 0.01
0.22
0.151.51
! 0.01
Control Yes
178 249
60.0 83.8
0.99
0.821.20
0.94
0.87
0.501.51
0.62
No Yes
48 72
16.1 24.2
0.69
0.590.84
! 0.01
0.39
0.251.51
0.62
No
225
75.8 1.05
0.951.17 1.002.21
0.33
Prior Endoscopic Experiance Sedation
Endoscopy Times GERD
Yes
133
45.5
No
159
54.4
1.16
1.011.34
0.04
1.48
0.06
Abbreviation: N, numbers; OR, odds ration; CI, confidence interval; GERD, gastroesophageal reflux disease. Foot notes: 1. Lidocaine spray was added on the tip of the endoscope before intubation among case group. Others with convetional pharyngeal anesthesia without lidocaine spray on the endoscope.
Su1514 Adverse Events Associated With Endoscopy for Food Bolus Impaction in Patients Receiving Conscious Sedation vs. Anesthesia Support With Elective Endotracheal Intubation Jose Melendez-Rosado*, Raul J. Badillo, Dawn L. Francis Mayo Clinic, Jacksonville, FL Purpose: Review the rate of adverse events associated with therapeutic upper endoscopy for esophageal food impaction in patients sedated with conscious sedation versus anesthesia supported sedation with elective endotracheal
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB311
(average 96 mcg). Average procedure length was 44 minutes. Average outpatient recovery was 119 minutes.Four adverse events were reported, including 1 case of hypotension and 3 cases of bradycardia. In all cases the adverse event resolved after suspension of DXM. In 3 cases, DCS was restarted without further incident. In the 4th case hypotension persisted, and the procedure was completed with fentanyl and midazolam only. In 2 other cases DCS was abandoned for MAC after the patients became too agitated to continue.The wholesale cost of DXM was $66.00 per procedure. The wholesale cost of propofol averaged $8.00 to $16.00 per procedure. There was no difference in the cost of midazolam and fentanyl when comparing DCS to MAC. The typical anesthesiologist charge was estimated to be $900.00 per case. Conclusion: Our data suggest that use of DCS was not associated with any significant adverse events. Endoscopists were uniformly satisfied with DCS.In this study the use of DCS was safe, effective and less costly than MAC. Further study is warranted.
Su1512 A Nationwide Web-Based Survey of Endoscopic Sedation and Concomitant Monitoring Practices in Korea Chang Kyun Lee*1,2, Eun Sun Kim3,2, Seok Ho Dong1,2, Sung-Hoon Moon4,2, Hong Jun Park5,2, Dong-Hoon Yang6,2, Tae Hoon Lee7,2, Sang Kil Lee8,2, Jong Jin Hyun3,2 1 Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea (the Republic of); 2the Korean Society of Gastrointestinal Endoscopy (KSGE) Task Force on Endoscopic Sedation, Seoul, Korea (the Republic of); 3internal medicine, Korea University College of Medicine, Seoul, Korea (the Republic of); 4Internal medicine, Hallym University College of Medicine, Anyang, Korea (the Republic of); 5Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of); 6University of Ulsan College of Medicine, Seoul, Korea (the Republic of); 7 Soonchunhyang University College of Medicine, Cheonan, Korea (the Republic of); 8Yonsei University College of Medicine, Seoul, Korea (the Republic of) Background: Wide variation exists in the use of endoscopic sedation and concomitant monitoring practices worldwide. Aims: This study explored endoscopists’ practices of sedation and monitoring in Korea. Methods: A 5-section, 35-item anonymous questionnaire was developed by the Korean Society of Gastrointestinal Endoscopy (KSGE) Task Force on Endoscopic Sedation. All members of the KSGE were invited to complete a Web-based self-reported questionnaire during the survey period (August 2014), and all data were transferred via the Web to a central database. Results: In total, 1332 of the 5860 invited KSGE members completed the survey, representing an overall response rate of 22.7%. The mean age of respondents was 43.4 years; 80.2% were men, and 82.4% were gastroenterologists. Forty-six percent of respondents practiced at private clinics, 26.2% practiced at nonacademic community hospitals, and 27.9% practiced at academic teaching hospitals. A vast majority of respondents (98.9%, 1318/1332) routinely performed procedural sedation for diagnostic esophagogastroduodenoscopy (99.1%) and colonoscopy (91.4%); the dominant method was midazolam alone for esophagogastroduodenoscopy (37.0%) and a combination of midazolam and propofol for colonoscopy (33.8%). Sixty-three percent of respondents (830/1318) routinely used propofol with a high physician satisfaction rating: 91.1% scored this technique as R7 points on a 10-point visual analog scale. Propofol was exclusively administered by non-anesthesiologists (99.8%). Community practitioners, gastroenterologists, or endoscopists with !10 years of practice experience were more likely to use propofol than were practitioners at academic hospitals, non-gastroenterologists, or endoscopists with O10 years of practice experience (67.7% vs. 50.9%, 65.8% vs. 49.1%, and 71.8% vs. 52.7%, respectively; all P ! 0.001). The fear of cardiopulmonary side effects was the most common reason cited for not currently using propofol (50.0%, 244/488). The majority of respondents (94.1%) routinely monitored patients using pulse oximetry, and 42.5% routinely administered supplemental oxygen. However, 38.3% of respondents rarely or never used the American Society of Anesthesiologists physical status classification for preprocedural assessment. A substantial proportion of respondents (8.9%) practiced sedation without targeted training for endoscopic sedation, and 27.4% practiced without sedation administration and monitoring protocols. Conclusions: Non-anesthesiologist-administered propofol sedation is becoming a standard practice during gastrointestinal endoscopy in Korea. The results of this survey suggest the need to address many important issues impacting the quality improvement in patient care, the development of appropriate training programs and, potentially, policy-making.
Su1513 Lidocaine Sprayed-on the Endoscope Can Improve the Tolerance During Upper Gastrointestinal Endoscopy? Byung Hyo Cha* Gastroenterology disease center, Che-ju Halla General Hospital, Che-ju, Korea (the Republic of) Backgrounds and aims: Topical pharyngeal anesthesia has been the standard preparation for reducing the discomfort during upper gastrointestinal endoscopy
www.giejournal.org
(UGIE). But it is not clear whether this method effective in regard to the tolerance of procedure. The aim of this study is to assess the efficacies of the added lidocaine spray on the tip of endoscope in improving patient tolerance. Methods: All the patients underwent upper gastrointestinal endoscopy were consecutively enrolled and assigned to case group with additional 2 puffs of the 10% lidocaine spray on the tip of endoscope before intubation or control group without additional spray. During the endoscopy, the main outcomes including frequency of retching and belching were measured by independent assistants. Results: Among 497 eligible patients, 262 were assigned to case group and 235 to control. In univariated and multivariated analysis, there was significant difference between two groups in terms of belching (case vs. control, OR Z 0.15, 95% CI Z 0.09 - 0.24, p ! 0.01) and retching (case vs. control, OR Z 0.22, 95% CI Z 0.15 - 0.34, p Z 0.01). Elderly showed less probability of belching events (age, OR Z 0.96, 95% CI Z 0.94 - 0.98, p! 0.01), female sex was found as another predictive value of the presence of belching (female vs. male, OR Z 2.16, 95% CI Z 1.40 - 3.33, p Z 0.01). The sedation and patients with GERD were revealed as the factors correlated to the presence of retching (sedated vs. nonsedated, OR Z 0.39, 95% CI Z 0.25-0.61, p Z 0.01; GERD vs. none, OR Z 1.48, 95% CI Z 1.00 - 2.21, p Z 0.06). Conclusions: The new methods adding lidocaine spray on the endoscope can improve the patient tolerance during UGIE.
Multivariated analysis of the factors contributing Two primary outcomes of endoscopy tolerance using Logistic regression model. (N[497) Presence of belching
Unadjusted N
% of belching
OR
Adjusted 95% CI
p Value
Age
OR
95% CI
0.96
0.940.98 1.403.33
p Value ! 0.01 0.01
Sex
Female
186
59.6
1.21
1.051.39
0.006
2.16
Groups
Male 1Case
126 120
40.4 46.1
0.55
0.480.69
! 0.01
0.15
0.090.24
! 0.01
Control Yes
192 261
83.1 83.7
0.98
0.821.71
0.82
0.81
0.451.45
0.48
No Yes
51 99
16.3 36.9
1.01
0.881.17
0.87
1.16
0.741.81
0.53
No
212
63.1 1.07
Yes
132
42.9
1.04
0.911.19
0.56
0.971.19 0.811.89
No
176
57.1
N
% of Retching
95% CI
p Value
Prior Endoscopy Experiance Sedation
Endoscopy Time GERD
Presence of Retching
Unadjusted OR
Age
1.22
Adjusted OR 0.22
95% CI 0.150.34 0.841.91
0.19 0.34
p Value ! 0.01 0.26
Sex
Female
167
56.2
1.05
0.911.22
0.59
1.27
Groups
Male 1Case
130 119
43.8 40.0
0.59
0.510.69
! 0.01
0.22
0.151.51
! 0.01
Control Yes
178 249
60.0 83.8
0.99
0.821.20
0.94
0.87
0.501.51
0.62
No Yes
48 72
16.1 24.2
0.69
0.590.84
! 0.01
0.39
0.251.51
0.62
No
225
75.8 1.05
0.951.17 1.002.21
0.33
Prior Endoscopic Experiance Sedation
Endoscopy Times GERD
Yes
133
45.5
No
159
54.4
1.16
1.011.34
0.04
1.48
0.06
Abbreviation: N, numbers; OR, odds ration; CI, confidence interval; GERD, gastroesophageal reflux disease. Foot notes: 1. Lidocaine spray was added on the tip of the endoscope before intubation among case group. Others with convetional pharyngeal anesthesia without lidocaine spray on the endoscope.
Su1514 Adverse Events Associated With Endoscopy for Food Bolus Impaction in Patients Receiving Conscious Sedation vs. Anesthesia Support With Elective Endotracheal Intubation Jose Melendez-Rosado*, Raul J. Badillo, Dawn L. Francis Mayo Clinic, Jacksonville, FL Purpose: Review the rate of adverse events associated with therapeutic upper endoscopy for esophageal food impaction in patients sedated with conscious sedation versus anesthesia supported sedation with elective endotracheal
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB311