Prosenz Julian, Lang René-Pascal, Bernhofer Sebastian, Maieron Andreas
GI Endoscopy Quality Matters Working Group (GIEQM), Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria.
Department of Internal Medicine 2, Gastroenterology & Hepatology, University Hospital St, Dunant-Platz 1, 3100, PöltenSt. Pölten, Austria.
Sci Rep. 2025 Jul 2;15(1):22781. doi: 10.1038/s41598-025-04922-4.
Little is known of the desaturation rate among NAPS (non-anesthesiological/nurse-administered propofol-sedation) ERCPs (endoscopic retrograde cholangiopancreatography) and endoscopists awareness of overall incidence of adverse events (AEs). The primary aims were to assess desaturation rates and endoscopists AE-awareness. In this prospective observation study, all ERCPs performed in a certain period were included. Nurses documented hypoxemia and measures taken to correct it. Charts were reviewed for clinical data. Definitions of AEs were based on the 2020 ESGE guidelines. Of 232 included ERCPs, 218 (94%) were conducted using NAPS. Mean age was 67.9 (SD 15.8) years, 53.2% were female, median ASA status was 2 (IQR 2;3). Most (86.8%) procedures were started on 2 L O2 flow/min (via nasal cannula), propofol mono-sedation was used in 98.2%. A desaturation occurred in 22.6% (n = 45) of procedures, and 28.1% (n = 56), when including interventions performed for hypoxemia. Risk factors for desaturations were higher BMI, and higher ASA status (p < 0.05). Documentation of AEs by endoscopists was exceptionally low. Only 22.2% of post-ERCP pancreatitis, 19% of intraprocedural bleeding, 20% of desaturations were officially recorded/documented. All-cause 30-day mortality was significantly higher in the desaturation group (10.7% vs. 2.8%, p = 0.03). Sedation-AEs are common and desaturation is statistically significantly associated with 30-day-mortality. Incidence of complications is underappreciated by endoscopists.
关于非麻醉科/护士实施丙泊酚镇静的内镜逆行胰胆管造影术（NAPS-ERCP）中的血氧饱和度下降率以及内镜医师对不良事件（AE）总体发生率的认知情况，目前所知甚少。主要目的是评估血氧饱和度下降率以及内镜医师对不良事件的认知。在这项前瞻性观察研究中，纳入了某一时期内进行的所有ERCP手术。护士记录低氧血症情况以及为纠正低氧血症所采取的措施。查阅病历以获取临床数据。不良事件的定义基于2020年欧洲消化内镜学会（ESGE）指南。在纳入的232例ERCP手术中，218例（94%）采用了NAPS。平均年龄为67.9（标准差15.8）岁，53.2%为女性，美国麻醉医师协会（ASA）状态中位数为2（四分位间距2；3）。大多数（86.8%）手术开始时采用2升/分钟的氧气流量（通过鼻导管），98.2%使用丙泊酚单一镇静剂。22.6%（n = 45）的手术出现了血氧饱和度下降，若包括针对低氧血症采取的干预措施，则为28.1%（n = 56）。血氧饱和度下降的风险因素包括较高的体重指数（BMI）和较高的ASA状态（p < 0.05）。内镜医师对不良事件的记录极低。ERCP术后胰腺炎只有22.2%、术中出血19%、血氧饱和度下降20%得到正式记录/存档。血氧饱和度下降组全因30天死亡率显著更高（10.7%对2.8%，p = 0.03）。镇静相关不良事件很常见，血氧饱和度下降与30天死亡率在统计学上有显著关联。内镜医师对并发症发生率的认识不足。
