Safety and efficacy of physician-administered balanced-sedation for the endoscopic mucosal resection of large non-pedunculated colorectal polyps

Sunil Gupta; Rajiv Kurup; Neal Shahidi; Sergei Vosko; Owen McKay; Simmi Zahid; Anthony Whitfield; Eric Y Lee; Stephen John Williams; Nicholas Graeme Burgess; Michael J Bourke

doi:10.1055/a-2180-8880

Safety and efficacy of physician-administered balanced-sedation for the endoscopic mucosal resection of large non-pedunculated colorectal polyps

Endosc Int Open. 2024 Jan 5;12(1):E1-E10. doi: 10.1055/a-2180-8880. eCollection 2024 Jan.

Authors

Sunil Gupta^{1

2}, Rajiv Kurup¹, Neal Shahidi^{1

2

3}, Sergei Vosko¹, Owen McKay¹, Simmi Zahid¹, Anthony Whitfield^{1

2}, Eric Y Lee^{1

2}, Stephen John Williams¹, Nicholas Graeme Burgess^{1

2}, Michael J Bourke^{1

2}

Affiliations

¹ Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.
² Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia.
³ Gastroenterology and Hepatology, The University of British Columbia Faculty of Medicine, Vancouver, Canada.

Abstract

Background and study aims Because of concerns about peri-procedural adverse events (AEs), guidelines recommend anesthetist-managed sedation (AMS) for long and complex endoscopic procedures. The safety and efficacy of physician-administered balanced sedation (PA-BS) for endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs) ≥20 mm is unknown. Patients and methods We compared PA-BS with AMS in a retrospective study of prospectively collected data from consecutive patients referred for management of LNPCPs (NCT01368289; NCT02000141). A per-patient propensity analysis was performed following a 1:2 nearest-neighbor (Greedy-type) match, based on age, gender, Charlson comorbidity index, and lesion size. The primary outcome was any peri-procedural AE, which included hypotension, hypertension, tachycardia, bradycardia, hypoxia, and new arrhythmia. Secondary outcomes were unplanned admissions, 28-day re-presentation, technical success, and recurrence. Results Between January 2016 and June 2020, 700 patients underwent EMR for LNPCPs, of whom 638 received PA-BS. Among them, the median age was 70 years (interquartile range [IQR] 62-76 years), size 35 mm (IQR 25-45 mm), and duration 35 minutes (IQR 25-60 minutes). Peri-procedural AEs occurred in 149 (23.4%), most commonly bradycardia (116; 18.2%). Only five (0.8%) required an unplanned sedation-related admission due to AEs (2 hypotension, 1 arrhythmia, 1 bradycardia, 1 hypoxia), with a median inpatient stay of 1 day (IQR 1-3 days). After propensity-score matching, there were no differences between PA-BS and AMS in peri-procedural AEs, unplanned admissions, 28-day re-presentation rates, technical success or recurrence. Conclusions Physician-administered balanced sedation for the EMR of LNPCPs is safe. Peri-procedural AEs are infrequent, transient, rarely require admission (<1%), and are experienced in similar frequencies to those receiving anesthetist-managed sedation.

Keywords: Performance and complications; Quality and logistical aspects; Sedation and monitoring.

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