Department of Gastroenterology, Herlev-Gentofte University Hospital, Herlev, Denmark.
Department of Gastroenterology, Herlev-Gentofte University Hospital, Herlev, Denmark.
Clin Gastroenterol Hepatol. 2022 Mar;20(3):559-568.e5. doi: 10.1016/j.cgh.2020.10.037. Epub 2020 Oct 22.
BACKGROUND & AIMS: Colonoscopy is essential for optimal management of inflammatory bowel disease. However, many patients opt out due to unpleasantness related to this procedure. We investigated if Nurse Administered Propofol Sedation (NAPS) would improve patient satisfaction and attitude towards future colonoscopies.
Randomized clinical trial of deep sedation with NAPS (n = 63) versus moderate midazolam and fentanyl sedation (n = 67). To assess the primary end point of patient satisfaction at discharge, we developed a Satisfaction Questionnaire comprising 13 items each rated by a 5-point Likert scale and with higher scores reflecting more positive outcomes (13-65 points).
Fifty-six patients (43%) with ulcerative colitis, 48 (37%) with Crohn's disease, and 26 (20%) with high suspicion of inflammatory bowel disease were included. Most (88%) had previously had a colonoscopy and pre-procedure expectations were similar between groups. Patients receiving deep sedation had significantly higher satisfaction score (mean 60.1, SD 3.4) than those receiving moderate sedation (51.2, 8.4; P < .001). This was driven especially by less pain, more amnesia, sedation more to their liking, and better experience with the current than previous sedations. Importantly, these patients significantly more often preferred the same sedation for a future colonoscopy and were also inclined to accept more frequent colonoscopies. Assistance from another colonoscopist and disruption of the procedure due to pain occurred significantly more frequent in the moderate sedation group. There were no safety signals associated with NAPS.
Patients with inflammatory bowel disease favor deep propofol sedation over moderate midazolam and fentanyl sedation. Availability of NAPS may facilitate patient adherence to endoscopy-based monitoring programs. Clinicaltrials.gov NCT01934088.
结肠镜检查对于炎症性肠病的最佳管理至关重要。然而，由于该程序引起的不适，许多患者选择放弃。我们研究了护士管理的异丙酚镇静（NAPS）是否会提高患者对未来结肠镜检查的满意度和态度。
对深度镇静的 NAPS（n = 63）与中度咪达唑仑和芬太尼镇静（n = 67）进行随机临床试验。为了评估出院时患者满意度的主要终点，我们开发了一个满意度问卷，共包含 13 个项目，每个项目均采用 5 分制进行评分，得分越高表示结果越积极（13-65 分）。
56 例溃疡性结肠炎（43%）、48 例克罗恩病（37%）和 26 例高度怀疑炎症性肠病（20%）患者纳入研究。大多数（88%）患者以前曾进行过结肠镜检查，两组患者的术前预期相似。接受深度镇静的患者满意度评分明显高于接受中度镇静的患者（60.1，3.4；51.2，8.4；P <.001）。这主要是由于疼痛减轻、遗忘更多、镇静更符合患者喜好以及当前镇静效果优于以往镇静。重要的是，这些患者在未来的结肠镜检查中更倾向于选择相同的镇静，并且也更倾向于接受更频繁的结肠镜检查。在中度镇静组中，由于疼痛需要另一位结肠镜医生协助以及因疼痛而中断检查的情况更为常见。NAPS 没有出现安全性信号。
炎症性肠病患者更倾向于选择深度异丙酚镇静，而不是中度咪达唑仑和芬太尼镇静。NAPS 的应用可能有助于提高患者对基于内镜监测计划的依从性。Clinicaltrials.gov NCT01934088。
