Optimal sequences of same-visit bidirectional endoscopy: Systematic review and meta-analysis

Dig Endosc. 2020 Jul;32(5):706-714. doi: 10.1111/den.13503. Epub 2019 Oct 13.


Background and aim: Same-visit colonoscopy and esophagogastroduodenoscopy (EGD) have become common. Recent studies showed conflicting results regarding the performance, safety, and efficacy of different sequences. We conducted this meta-analysis to determine the most favorable performance and discomfort between an EGD followed by colonoscopy (E-C) and colonoscopy followed by EGD (C-E).

Methods: The authors searched the databases of MEDLINE and EMBASE. Outcomes of interest were performance (including cecal intubation time, adenoma detection rate, and polyp detection rate), discomfort score (patients and endoscopists; Likert scale), and sedation uses. Pooled mean differences (MD) or odds ratios (OR) were calculated with 95% confidence intervals (CI).

Results: Six randomized controlled trials were included in the meta-analysis. The authors found that there was significantly lower sedative use including fentanyl (14.70; 95% Cl: 8.20-21.20) and propofol (15.58; 95% Cl: 3.27-27.89) in the E-C group compared with the C-E group. There was a significantly better discomfort score in patients and endoscopists after both procedures in the E-C group than in the C-E group with pooled MD of 0.64 points (95% Cl: 0.09-1.20) and 0.47 (95% Cl: 0.05-0.90), respectively. There were no differences in cecal intubation time, adenoma detection rate, or polyp detection rate between the two groups.

Conclusion: The present study found that the discomfort score was better in the E-C group. However, there was no difference in polyp and adenoma detection. Therefore, the E-C group is the optimal sequence.

Keywords: bidirectional endoscopy; colonoscopy; discomfort; optimal sequence; upper endoscopy.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Cecum*
  • Colonoscopy
  • Endoscopy, Digestive System
  • Humans
  • Hypnotics and Sedatives
  • Propofol*


  • Hypnotics and Sedatives
  • Propofol