Comparison of procedural sequences in same-day painless bidirectional endoscopy: Single-center, prospective, randomized study.
BACKGROUND AND AIM
To compare the efficacy and safety of esophagogastroduodenoscopy (EGD)-colonoscopy and colonoscopy-EGD sequences for patients subjected to same-day bidirectional endoscopy under remifentanil and propofol sedation.


METHODS
A total of 209 eligible outpatients scheduled for diagnostic same-day bidirectional endoscopy between 16 February 2016 and 30 April 2016 were randomly assigned to the EGD-colonoscopy (n = 106) and colonoscopy-EGD (n = 103) sequence groups. Primary endpoint was total dose of propofol required for the procedure. Secondary endpoints included duration of endoscopy, patient satisfaction, adverse effects, endoscopy findings, and cardiopulmonary responses of the patients.


RESULTS
Patients in the two groups were similar in terms of demographic and clinical data (P > 0.05). EGD-colonoscopy sequence group had lesser requirement of propofol for sedation (P < 0.05), faster recovery (P < 0.001), and lesser influence on mean arterial pressure (MAP) during the endoscopy (P < 0.05). Duration of EGD and colonoscopy, patient satisfaction, adverse effects, and pathological findings did not differ between the two groups.


CONCLUSIONS
The EGD-colonoscopy sequence may be considered the preferred sequence for same-day bidirectional endoscopy as a result of less cardiovascular stress, lessened need for sedation with propofol, and faster recovery.
['Cao|Yan|Y|', 'Yang|Jun|J|', 'Li|Jiao|J|', 'Ao|Xin|X|', 'Zhang|Kai-Yuan|KY|', 'Shen|Xiao-Chun|XC|', 'Chen|Dong-Feng|DF|', 'Lan|Chun-Hui|CH|http://orcid.org/0000-0001-5120-5135']
D000293:Adolescent D000328:Adult D000368:Aged D003108:Colonic Diseases D003113:Colonoscopy D016292:Conscious Sedation D005260:Female D006801:Humans D006993:Hypnotics and Sedatives D008297:Male D008875:Middle Aged D017060:Patient Satisfaction D015742:Propofol D011446:Prospective Studies D016896:Treatment Outcome D055815:Young Adult
sequence esophagogastroduodenoscopy same-day bidirectional endoscopy cardiopulmonary response colonoscopy