Comparison of procedural sequence in same-day consecutive bidirectional endoscopy using moderate sedation: a prospective randomized study

J Clin Gastroenterol. 2014 Mar;48(3):236-40. doi: 10.1097/MCG.0b013e3182a87e5f.


Background: A sequential bidirectional endoscopy is commonly performed. However, the optimal sequence of procedures for same-day bidirectional endoscopy using moderate sedation has not been established.

Goals: The aim of this study was to characterize the optimal sequence of endoscopies for sequential bidirectional endoscopy.

Study: This was a single-center, prospective, randomized study. A total of 163 patients aged 18 to 80 years, who were referred for bidirectional endoscopy for any indication, were randomized to start with upper or lower endoscopy. Initially, all patients received intravenously 50 mg of meperidine and 2.5 mg of midazolam. Patient's discomfort and satisfaction, as expressed by the amount of analgesia added to sustain conscious sedation, and the postprocedure satisfaction reported by the patients were set as primary outcomes.

Results: There was no significant difference in the total dose of midazolam added, patient's pain assessment and satisfaction from the anesthesia and the procedure, duration of endoscopies, or the time to cecal intubation between the esophagogastroduodenoscopy first and colonoscopy first groups. The rate of diagnosis of significant pathologies and the rate of procedures performed during the examinations were similar in both the study groups. Evaluation of patient's postprocedural recovery did not reveal significant differences. There was no significant variance between the performing physicians regarding anesthetic dosing, duration of examination, pain scoring, and the related patient's pain postprocedural assessment.

Conclusions: There were no significant differences in the patient's discomfort and satisfaction, regardless of the procedural sequence.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Conscious Sedation* / adverse effects
  • Endoscopy, Gastrointestinal / adverse effects
  • Endoscopy, Gastrointestinal / methods*
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Hypnotics and Sedatives / adverse effects
  • Israel
  • Male
  • Midazolam / administration & dosage*
  • Midazolam / adverse effects
  • Middle Aged
  • Pain / etiology
  • Pain / prevention & control
  • Pain Measurement
  • Patient Satisfaction
  • Predictive Value of Tests
  • Prospective Studies
  • Surveys and Questionnaires
  • Time Factors
  • Young Adult


  • Hypnotics and Sedatives
  • Midazolam