Abstract and Introduction
Abstract
Background Guidelines and practice standards for sedation in endoscopy have been developed by various national professional societies. No attempt has been made to assess consensus among internationally recognized experts in this field.
Aim To identify areas of consensus and dissent among international experts on a broad range of issues pertaining to the practice of sedation in digestive endoscopy.
Methods Thirty-two position statements were reviewed during a 1 ½-day meeting. Thirty-two individuals from 12 countries and four continents, representing the fields of gastroenterology, anaesthesiology and medical jurisprudence heard evidence-based presentations on each statement. Level of agreement among the experts for each statement was determined by an open poll.
Results The principle recommendations included the following: (i) sedation improves patient tolerance and compliance for endoscopy, (ii) whenever possible, patients undergoing endoscopy should be offered the option of having the procedure either with or without sedation, (iii) monitoring of vital signs as well as the levels of consciousness and pain/discomfort should be performed routinely during endoscopy, and (iv) endoscopists and nurses with appropriate training can safely and effectively administer propofol to low-risk patients undergoing endoscopic procedures.
Conclusions While the standards of practice vary from country to country, there was broad agreement among participants regarding most issues pertaining to sedation during endoscopy.
Introduction
Sedation and analgesia comprise an important element of many endoscopic examinations, improving the quality of examination and contributing to the willingness of patients to undergo gastrointestinal procedures. Worldwide, patient attitudes and expectations are changing the way that endoscopists view sedation practice. Intravenous combinations of a sedative and analgesic have been used in many parts of the world for years, and have generally been administered by an endoscopist or nurse assistant. Recently, concerns have been expressed that sedative use may itself cause complications and (rarely) death. This issue has become more controversial with the introduction of propofol, a short-acting hypnotic agent, which many endoscopists and patients find superior to traditional sedation, but which, in some jurisdictions, can be administered only by a licensed anaesthetist. This document is intended to provide a worldwide perspective on the practice of sedation during digestive endoscopy.
The content of this international position statement represents a synthesis of evidence-based scientific literature, expert opinion, panel commentary and consensus view. The statements are intended to assist clinicians in decision making in order to optimize the safety and effectiveness of sedation. The statements and accompanying discussion are not intended as standards, guidelines, or absolute requirements. The panel acknowledges that standards of endoscopy and sedation vary widely among countries, and that application of these practice recommendations will necessarily vary in extent within different countries and regions. All known national and international statements pertaining to sedation practice and digestive endoscopy were reviewed and consulted in the preparation of this publication.
The World Organization of Digestive Endoscopy (OMED), the Hellenic Society of Gastroenterology (HSG), and European Society of Gastrointestinal Endoscopy (ESGE) decided jointly to hold an international workshop in order to produce a position statement on the indications for sedation in endoscopy, safe administration, patient monitoring and training of personnel involved with its use.
The workshop took place in Athens on 18–19 September 2009. Funding for the meeting was provided by the three societies and the United European Gastroenterology Federation (UEGF), without direct sponsorship from the biomedical industry that did not take part either in the meeting itself or in the preparation of this report. The meeting was endorsed by the American Society for Gastrointestinal Endoscopy (ASGE).