Sedation practices in Gastrointestinal Endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) survey

INTRODUCTION

The provision of moderate sedation for gastrointestinal (GI) endoscopic procedures is considered the standard of care in most of the world. Endoscopic procedural sedation increases patient compliance, enhances satisfaction for both the patient and the endoscopist, and facilitates procedural safety and effectiveness. Moreover, with the increasing complexity of interventional endoscopic procedures, deeper sedation and even general anesthesia are often required [1]. However, the provision of sedation in GI endoscopy presents several limitations, including prolonged patient recovery times, increased health care costs, and greater risks of cardiopulmonary adverse events (AEs) [2]. Furthermore, there is ongoing debate regarding who should legitimately be administering endoscopic procedural sedation, particularly propofol and other novel sedative agents [3, 4]. In tandem, there is varied practice in endoscopists’ adherence to guidelines for sedation administration, patients’ pre-procedural risk stratification, and the management of sedation-related AEs. In addition, the provision of training in procedural sedation remains nonstandardized and there is a paucity of data on cost-effective approaches to enhance resource use in relation to sedation practices [5, 6, 7].

Currently, sedation and monitoring practices for GI endoscopy vary widely based on endoscopists’ and patients’ preferences, cultural attitudes, healthcare resource availability, local policies, and national legislation [6, 8, 9]. Previous surveys of sedation practice patterns among endoscopists have revealed variations in sedation rates, preferred sedation regimens, and patient monitoring practices; however, these practices have been subject to change over time [5, 10, 11, 12].

The European Society of Gastrointestinal Endoscopy (ESGE) is comprised of 41 member societies from Europe, North Africa, and the Middle East, as well as thousands of individual members worldwide. The ESGE’s mission is to educate, innovate, disseminate, support, and promote quality in the practice of GI endoscopy through published guidance documents.

Given the limited understanding of sedation practices among ESGE individual members, the ESGE Guidelines Committee and Curricula Working Group conducted an online web-based survey among ESGE individual members to obtain information on endoscopists’ professional characteristics, prior sedation training, and sedation practices for endoscopic procedures, and information on the patient journey for GI endoscopic procedures from pre-assessment to discharge. We believe these data, reflecting real-life endoscopy practice, could be a valuable resource to highlight areas to enhance the quality of sedation practice provided to patients undergoing GI endoscopic procedures, improve the provision of sedation training programs, and potentially influence policy making for procedural sedation