Safety and Efficacy of Sedation During Emergency Endoscopy for Upper Gastrointestinal Bleeding: A Propensity Score Matching Analysis

• Published in: Digestive diseases and sciences Vol. 68; no. 4; pp. 1426 - 1434
• Main Authors: Yamaguchi, Daisuke, Nagatsuma, Goshi, Sakata, Yasuhisa, Mizuta, Yumi, Nomura, Tadahiro, Jinnouchi, Azuki, Gondo, Kasumi, Asahi, Ryosuke, Ishida, Satoshi, Kimura, Shunichiro, Fujimoto, Shun, Shimakura, Akane, Jubashi, Amane, Takeuchi, Yuki, Ikeda, Kei, Tanaka, Yuichiro, Yoshioka, Wataru, Hino, Naoyuki, Morisaki, Tomohito, Ario, Keisuke, Tsunada, Seiji, Esaki, Motohiro
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2023; Springer Nature B.V
• Subjects: Anesthesia; Biochemistry; Endoscopy; Endoscopy, Gastrointestinal - adverse effects; Gastroenterology; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Mortality; Oncology; Original; Original Article; Peptic Ulcer - complications; Propensity Score; Retrospective Studies; Transplant Surgery; Propensity score matching; Emergency endoscopy; Sedation; Mortality; Bleeding
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-022-07740-0

Background and Aim This study aimed to compare patients with and without sedation during emergency endoscopy for upper gastrointestinal bleeding (UGIB) and to clarify the safety and efficacy of sedation in emergency endoscopy. Methods We retrospectively collected 389 patients who underwent emergency endoscopy for UGIB at Ureshino Medical Center from 2016 to 2021. Patients were divided into two groups: sedation group during emergency endoscopy and nonsedation group. Clinical characteristics, patient status on admission, and UGIB etiology were evaluated. Treatment outcomes and adverse events were evaluated using propensity score matching (PSM), and risk factors for mortality from UGIB were investigated using Cox multivariate analysis. Results The sedation group was significantly younger, composed of a higher proportion of males, and had chronic liver disease. Blood pressure and hemoglobin level on admission were significantly higher in the sedation group. The main cause of bleeding was peptic ulcer, which was significantly higher in the nonsedation group. PSM created 133 matched pairs. The success rate of endoscopic hemostasis was similar in both groups, and procedure time was significantly shorter in the sedation group than in the nonsedation group (17.6 ± 10.0 versus 20.2 ± 10.2 min, P  = 0.04). There were no significant differences in adverse events between groups. Cox multivariate analyses revealed that red blood cell transfusion [hazard ratio (HR) 4.45, P  < 0.02] and rebleeding (HR 3.30, P  = 0.03) were associated with increased risk of 30-day mortality from UGIB. Conclusions Sedation reduced the procedure time during emergency endoscopy for UGIB. Sedation during emergency endoscopy for UGIB is acceptable for safe endoscopic procedures.