Are Anesthesia Specialists Necessary for Complex Colorectal Endoscopic Mucosal Resections?

Sedation practice for endoscopy varies widely in the United States. One model is to use anesthesia specialists to administer propofol for complex endoscopic procedures, such as endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and endoscopic submucosal dissection.

In this report, investigators describe the outcomes of physician-administered balanced propofol sedation (along with the use of opioids and benzodiazepines) for endoscopic mucosal resection (EMR) of nonpedunculated colorectal lesions ≥20 mm in size. Over a 4-year interval, 700 patients underwent EMR, with 638 receiving propofol sedation administered either by an advanced endoscopy fellow or the consulting gastroenterologist supervising the procedure. 

During the interval, the use of this model increased from 87.1% to 95.8%, with the remainder of patients receiving sedation from an anesthetist. Compared with patients who received sedation administered by an anesthetist, patients receiving balanced propofol sedation given by an endoscopist had a median age 4 years younger and a lower Charlson Comorbidity Index. Before and after propensity score matching, there was no difference between the endoscopist-sedated and anesthetist-sedated patients in periprocedural events, such as hypotension, hypertension, arrhythmia, and hypoxia, and there was no difference in other adverse events, including immediate or delayed adverse events of the procedure, need for hospitalization, technical success of the procedure, and recurrence rates at first follow-up. This was also true for more complex resections, including those involving the ileocecal valve, anorectal junction, and a prior attempt at resection.