Smith Zachary L, Nickel Katelin B, Olsen Margaret A, Vargo John J, Kushnir Vladimir M
Gastroenterology and Liver Disease, University Hospitals, Cleveland, Ohio, USA.
Division of Gastroenterology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
Frontline Gastroenterol. 2019 May 9;11(2):104-110. doi: 10.1136/flgastro-2019-101175. eCollection 2020 Mar.
Recent studies suggest that sedation provided by anaesthesia professionals may be less protective against serious adverse events than previously believed, however, data are lacking regarding endoscopic retrograde cholangiopancreatography (ERCP). Using the clinical outcomes research initiative national endoscopic database (CORI-NED), we aimed to assess whether mode of sedation was associated with rates of unplanned interventions (UIs) during ERCP.
All subjects from CORI-NED undergoing ERCP from 2004 to 2014 were identified and stratified into three groups based on the initial mode of anaesthesia: endoscopist-directed sedation (EDS), monitored anaesthesia care without an endotracheal tube (MAC-WET) and general endotracheal anaesthesia (GEA). The primary outcome was UIs. To assess the impact of sedation mode on UIs, multivariable logistic regression models were created adjusting for demographic, physician and procedure-level variables.
Population-based study.
26 698 ERCPs were analysed (7588 EDS, 8395 MAC-WET, 10 715 GEA). UIs occurred in 320 ERCPs (1.2%). EDS was associated with a higher risk of UIs compared with sedation administered by an anaesthesia professional (OR 1.86, 95% CI 1.44 to 2.42). Additional factors associated with a higher risk of UIs included ASA class IV compared with class II (OR 3.18, 95% CI 2.00 to 5.06) and ERCPs done in community (OR 1.41, 1.04 to 1.91) and health maintenance organisations (OR 3.75, 2.01 to 6.99) hospitals.
EDS is associated with a higher risk of UIs during ERCP compared with sedation administered by an anaesthesia professional. Higher ASA class and procedures performed in non-university hospitals were also associated with a higher risk of UIs. This study suggests that, when available, sedation using an anaesthesia professional should be utilised for ERCP.
近期研究表明，麻醉专业人员提供的镇静对严重不良事件的保护作用可能不如先前认为的那样强，然而，关于内镜逆行胰胆管造影术（ERCP）的数据却很匮乏。我们利用临床结局研究计划国家内镜数据库（CORI-NED），旨在评估镇静方式是否与ERCP期间的非计划干预（UI）发生率相关。
确定CORI-NED中2004年至2014年接受ERCP的所有受试者，并根据初始麻醉方式将其分为三组：内镜医师指导下的镇静（EDS）、无气管插管的监护麻醉（MAC-WET）和全身气管内麻醉（GEA）。主要结局为UI。为评估镇静方式对UI的影响，建立了多变量逻辑回归模型，并对人口统计学、医生和操作层面的变量进行了调整。
基于人群的研究。
共分析了26698例ERCP（7588例EDS、8395例MAC-WET、10715例GEA）。320例ERCP（1.2%）发生了UI。与麻醉专业人员实施的镇静相比，EDS与更高的UI风险相关（比值比1.86，95%可信区间1.44至2.42）。与更高的UI风险相关的其他因素包括：与ASA II级相比，ASA IV级（比值比3.18，95%可信区间2.00至5.06）以及在社区医院（比值比1.41，1.04至1.91）和健康维护组织医院（比值比3.75，2.01至6.99）进行的ERCP。
与麻醉专业人员实施的镇静相比，EDS在ERCP期间与更高的UI风险相关。更高的ASA分级以及在非大学医院进行的操作也与更高的UI风险相关。本研究表明，如有条件，ERCP应采用麻醉专业人员实施的镇静。
