Randomized trial comparing general anesthesia with anesthesiologist-administered deep sedation for ERCP in average-risk patients - 17/11/22

Doi : 10.1016/j.gie.2022.06.003

Adnan B. Alzanbagi, MD ¹, Tariq L. Jilani, MD ², Laeeque A. Qureshi, FCPS ¹, Ibrahim M. Ibrahim, MD ², Abdulaziz M.S. Tashkandi, MD ¹, Eman E.A. Elshrief, MD ², Mohammed S. Khan, MD ¹, Manal A.H. Abdelhalim, MD ², Saad A. Zahrani, MD ¹, Wafaa M.K. Mohamed, MSc ², Ahmed M. Nageeb, MD ², Belal Abbushi, MD ², Mohammed K. Shariff, MD ^1,^⁎
¹ Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
² Department of Anesthesia, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia

^∗Reprint requests: Mohammed Kareem Shariff, MD, King Abdullah Medical City, PO Box 57657, Makkah Al Mukaramah, Kingdom of Saudi Arabia, 21955.King Abdullah Medical CityPO Box 57657Makkah Al MukaramahKingdom of Saudi Arabia21955

Abstract

Background and Aims

General anesthesia (GA) or monitored anesthesia care (MAC) is increasingly used to perform ERCP. The definitive choice between the 2 sedative types remains to be established. This study compared outcomes of GA with MAC in ERCP performed in patients at average risk for sedation-related adverse events (SRAEs).

Methods

At a tertiary referral center, patients with American Society of Anesthesiologists (ASA) class ≤III were randomly assigned to undergo ERCP with MAC or GA. The main outcome was a composite of hypotension, arrhythmia, hypoxia, hypercapnia, apnea, and procedural interruption or termination defined as SRAEs. In addition, ERCP procedural time, success, adverse events, and endoscopist and patient satisfaction were compared.

Results

Of 204 randomized, 203 patients were evaluated for SRAEs (MAC, n = 96; GA, n = 107). SRAEs developed in 35% of the MAC cohort (34/96) versus 9% in the GA cohort (10/107), which was statistically significant (P < .001). Mean induction time for GA was significantly longer than that for MAC (10.3 ± 10 minutes vs 6.5 ± 10.8 minutes, respectively; P < .001). ERCP procedure time, recovery time, cannulation time and success, and procedure-related adverse events were not statistically different between the 2 sedative groups. The use of GA improved endoscopist and patient satisfaction (P < .001).

Conclusion

GA is safe with fewer SRAEs than MAC in patients with ASA scores ≤III undergoing ERCP. Apart from prolonging induction time, use of GA does not change the procedural success or ERCP-related adverse events and offers greater endoscopist and patient satisfaction. Hence, GA is a consideration in patients undergoing ERCP in this population group. (Clinical trial registration number: NCT04099693.)

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