Sequence of same-day upper and lower gastrointestinal endoscopy does not affect total procedure' time or medication use: A randomized trial

Muhammad B Hammami; Kavya M Reddy; Pratik Pandit; Elie J Chahla; Nabeel Koro; Matthew J Schuelke; Christine Hachem

doi:10.1002/jgh3.12203

Sequence of same-day upper and lower gastrointestinal endoscopy does not affect total procedure' time or medication use: A randomized trial

JGH Open. 2019 Aug 6;3(6):488-493. doi: 10.1002/jgh3.12203. eCollection 2019 Dec.

Authors

Muhammad B Hammami¹, Kavya M Reddy¹, Pratik Pandit², Elie J Chahla¹, Nabeel Koro¹, Matthew J Schuelke³, Christine Hachem¹

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine Saint Louis University School of Medicine St. Louis Missouri USA.
² Department of Internal Medicine Saint Louis University, School of Medicine St. Louis Missouri USA.
³ Research Strategy Group Saint Louis University, Office of the Vice President for Research St. Louis Missouri USA.

Abstract

Background and aim: Same-day double upper and lower gastrointestinal endoscopy is frequently performed due to overlapping indications. However, it is unclear whether an upper-lower (U-L) or lower-upper (L-U) sequence is optimal. We analyzed the effect of sequence on total procedure time and sedation use.

Methods: A total of 100 patients scheduled for same-day double endoscopy were randomized to the U-L or L-U sequence arm. Primary outcomes, mean total procedure time, and sedative dosages were compared using a t-test. We also explored associations of the primary outcomes with patient-related and procedure-related factors.

Results: Comparing U-L and L-U sequences, mean total procedure time was 41.9 (16.2) versus 43.0 (14.5) min (P = 0.73), diphenhydramine dose 5.5 (15.4) versus 4.5 (14.0) mg (P = 0.74), fentanyl dose 71.5 (119.3) versus 77.6 (164.02) μg (P = 0.83), midazolam dose 1.6 (2.5) versus 1.4 (2.7) mg (P = 0.69), and propofol dose 437.4 (351.4) versus 444.5 (256.0) mg (P = 0.91), respectively. Total procedure and upper endoscopy times were significantly longer with trainee presence (P = 0.0002) and shorter with conscious sedation (P = 0.003). Upper endoscopy time was longer with higher body mass index (P = 0.001), and lower endoscopy time was longer in patients with cirrhosis or chronic kidney disease (P = 0.002 and 0.009, respectively). Time between procedures was significantly longer in the L-U sequence (7.4 [2.9] vs 5.3 [1.1] min, [P < 0.001]). The study had 80% power to detect an 8 min difference in total procedure time.

Conclusions: The sequence of same-day double gastrointestinal endoscopy does not affect total procedure time or medication use. Longer total procedure and upper endoscopy times were associated with trainee presence and use of conscious sedation.

Keywords: colonoscopy; digestive system endoscopy; endoscopy.