PMID- 38188923 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240112 IS - 2364-3722 (Print) IS - 2196-9736 (Electronic) IS - 2196-9736 (Linking) VI - 12 IP - 1 DP - 2024 Jan TI - Safety and efficacy of physician-administered balanced-sedation for the endoscopic mucosal resection of large non-pedunculated colorectal polyps. PG - E1-E10 LID - 10.1055/a-2180-8880 [doi] AB - 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. CI - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). FAU - Gupta, Sunil AU - Gupta S AUID- ORCID: 0000-0003-3471-8304 AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 AD - Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia. RINGGOLD: 216997 FAU - Kurup, Rajiv AU - Kurup R AUID- ORCID: 0000-0001-8207-115X AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 FAU - Shahidi, Neal AU - Shahidi N AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 AD - Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia. RINGGOLD: 216997 AD - Gastroenterology and Hepatology, The University of British Columbia Faculty of Medicine, Vancouver, Canada. RINGGOLD: 12358 FAU - Vosko, Sergei AU - Vosko S AUID- ORCID: 0000-0002-5600-2668 AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 FAU - McKay, Owen AU - McKay O AUID- ORCID: 0000-0001-8280-216X AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 FAU - Zahid, Simmi AU - Zahid S AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 FAU - Whitfield, Anthony AU - Whitfield A AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 AD - Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia. RINGGOLD: 216997 FAU - Lee, Eric Y AU - Lee EY AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 AD - Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia. RINGGOLD: 216997 FAU - Williams, Stephen John AU - Williams SJ AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 FAU - Burgess, Nicholas Graeme AU - Burgess NG AUID- ORCID: 0000-0003-4434-1627 AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 AD - Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia. RINGGOLD: 216997 FAU - Bourke, Michael J AU - Bourke MJ AD - Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia. RINGGOLD: 8539 AD - Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia. RINGGOLD: 216997 LA - eng PT - Journal Article DEP - 20240105 PL - Germany TA - Endosc Int Open JT - Endoscopy international open JID - 101639919 PMC - PMC10769574 OTO - NOTNLM OT - Performance and complications OT - Quality and logistical aspects OT - Sedation and monitoring COIS- Conflict of Interest Michael J. Bourke: research support from Olympus Medical, Cook Medical and Boston Scientific. The remaining authors have no conflicts of interest to disclose. EDAT- 2024/01/08 06:43 MHDA- 2024/01/08 06:44 PMCR- 2024/01/01 CRDT- 2024/01/08 05:26 PHST- 2022/12/24 00:00 [received] PHST- 2023/08/17 00:00 [accepted] PHST- 2024/01/08 06:44 [medline] PHST- 2024/01/08 06:43 [pubmed] PHST- 2024/01/08 05:26 [entrez] PHST- 2024/01/01 00:00 [pmc-release] AID - EIO-2022-12-2912-OA [pii] AID - 10.1055/a-2180-8880 [doi] PST - epublish SO - Endosc Int Open. 2024 Jan 5;12(1):E1-E10. doi: 10.1055/a-2180-8880. eCollection 2024 Jan.