Prospective Evaluation of Gastroenterologist-Guided, Nurse-Administered Standard Sedation for Spiral Deep Small Bowel Enteroscopy

Author: Judah J.   Collins D.   Gaidos J.   Hou W.   Forsmark C.   Draganov P.  

Publisher: Springer Publishing Company

ISSN: 0163-2116

Source: Digestive Diseases and Sciences, Vol.55, Iss.9, 2010-09, pp. : 2584-2591

Disclaimer: Any content in publications that violate the sovereignty, the constitution or regulations of the PRC is not accepted or approved by CNPIEC.

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Abstract

Sedation of patients for deep small bowel enteroscopy presents unique challenges and is traditionally provided by anesthesiologists. No study has directly evaluated gastroenterologist-guided, nurse-administered sedation for deep enteroscopy. Further, no comparison exists between gastroenterologist-guided versus anesthesiologist-guided sedation during deep enteroscopy.To evaluate safety and efficacy of performing deep (spiral) enteroscopy using gastroenterologist-guided sedation and compare outcomes between patients receiving gastroenterologist-guided and anesthesiologist-guided sedation.This prospective case series contains 91 consecutive patients who underwent deep enteroscopy with spiral Endo-Ease Discovery SB overtube. Of the patients, 64 received gastroenterologist-guided and 27 received anesthesiologist-guided sedation.In the 64 patients receiving gastroenterologist-guided sedation, successful completion occurred in 59 of 64 enteroscopies (92.2%). Mean insertion depth was 231.0 ± 85.8 cm beyond the ligament of Treitz. Total procedure time was 39.9 ± 15.7 min (diagnostic time 34.7 ± 12.3 min; therapy time 5.2 ± 8.9 min). Positive findings were noted in 32 cases (50.0%), with therapy performed in 27 cases (42.2%). Six minor complications occurred. Compared to the anesthesiologist-guided sedation group, there was no difference in patient characteristics except mean American Society of Anesthesiologists score (2.5 ± 0.5 in gastroenterologist-guided group versus 2.7 ± 0.6 in anesthesiologist-guided group; p = 0.046) and presence of adhesions (ten in gastroenterologist-guided group and zero in anesthesiologist-guided group; p = 0.030). Outcomes for both groups were not significantly different except for shorter times in the gastroenterologist-guided group (39.9 ± 15.7 min versus 46.0 ± 12.1 min; p = 0.047) and more frequent findings in the anesthesiologist-guided group (50.0% vs. 74.1%; p = 0.034).Deep enteroscopy using the spiral overtube can be successfully and safely accomplished with gastroenterologist-guided, nurse-administered standard sedation.