*Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan †Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
J Clin Gastroenterol. 2014 Mar;48(3):236-40. doi: 10.1097/MCG.0b013e3182a87e5f.
A sequential bidirectional endoscopy is commonly performed. However, the optimal sequence of procedures for same-day bidirectional endoscopy using moderate sedation has not been established.
The aim of this study was to characterize the optimal sequence of endoscopies for sequential bidirectional endoscopy.
This was a single-center, prospective, randomized study. A total of 163 patients aged 18 to 80 years, who were referred for bidirectional endoscopy for any indication, were randomized to start with upper or lower endoscopy. Initially, all patients received intravenously 50 mg of meperidine and 2.5 mg of midazolam. Patient's discomfort and satisfaction, as expressed by the amount of analgesia added to sustain conscious sedation, and the postprocedure satisfaction reported by the patients were set as primary outcomes.
There was no significant difference in the total dose of midazolam added, patient's pain assessment and satisfaction from the anesthesia and the procedure, duration of endoscopies, or the time to cecal intubation between the esophagogastroduodenoscopy first and colonoscopy first groups. The rate of diagnosis of significant pathologies and the rate of procedures performed during the examinations were similar in both the study groups. Evaluation of patient's postprocedural recovery did not reveal significant differences. There was no significant variance between the performing physicians regarding anesthetic dosing, duration of examination, pain scoring, and the related patient's pain postprocedural assessment.
There were no significant differences in the patient's discomfort and satisfaction, regardless of the procedural sequence.
通常会进行序贯双向内镜检查。然而，在中度镇静下同一天进行双向内镜检查的最佳程序顺序尚未确定。
本研究的目的是确定序贯双向内镜检查的最佳内镜检查顺序。
这是一项单中心、前瞻性、随机研究。共有 163 名年龄在 18 至 80 岁之间的患者因任何适应症而被转介进行双向内镜检查，他们被随机分为先进行上消化道内镜检查或下消化道内镜检查。最初，所有患者均静脉注射 50mg 哌替啶和 2.5mg 咪达唑仑。患者的不适和满意度（表示为维持清醒镇静所需的额外镇痛剂量）以及患者报告的术后满意度作为主要结局。
在上消化道内镜检查组和下消化道内镜检查组之间，咪达唑仑的总剂量、患者对麻醉和手术的疼痛评估和满意度、内镜检查的持续时间或盲肠插管的时间均无显著差异。两组研究中诊断出显著病理学的比率和检查过程中进行的手术比率相似。患者术后恢复的评估没有发现显著差异。麻醉药物剂量、检查持续时间、疼痛评分以及相关患者术后疼痛评估方面，术者之间没有显著差异。
无论程序顺序如何，患者的不适和满意度均无显著差异。
