Background and Study Aims: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. Th...Background and Study Aims: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally. Patients and Methods: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. Results: 6004 patients were included in this study, of whom 53%received conscious/moderate sedation during colonoscopy, 30%received deep sedation, and 17%received no sedation. Sedation agents most commonly used were midazolam (47%) and opioids (33%). Pulse oximetry was done during colonoscopy in 77%of patients, blood pressure monitoring in 34%, and electrocardiography in 24%. Pulse oximetry was most commonly used for moderately sedated patients, while blood pressure monitoring and electrocardiography were used predominantly for deeply sedated patients. Sedation and monitoring use ranged from 0%to 100%between centers. Oxygen desaturation (≤85%) occurred in 5%of patients, of whom 80%were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27%of colonoscopies, and during 85%of colonoscopies using deep sedation. Conclusions: Internationally, sedation and monitoring practice during colonoscopy varied widely. Moderate sedation was the most common sedation method used and electronic monitoring was used in three-quarters of patients. Deep sedation tended to be more resource-intensive, implying a greater use of staff and monitoring.展开更多
Background and study aim: Little is known about how gastroenterologists perceive the appropriateness of colonoscopies they perform. The objective of this study was to compare the appropriateness and necessity of colon...Background and study aim: Little is known about how gastroenterologists perceive the appropriateness of colonoscopies they perform. The objective of this study was to compare the appropriateness and necessity of colonoscopies as assessed by an expert panel and by the gastroenterologists performing the colonoscopies. Methods: This observational study included 21 centers in 11 countries. Patients referred for colonoscopy were consecutively included. Appropriateness and necessity of colonoscopies were independently rated on a 9-point scale by the gastroenterologists performing them and by an expert panel using a validated method (RAND). The differences between the ratings from the two groups were examined. Results: 6004 patients were included in the study. Comparisons of ratings were possible for 5381 (89.6% ) patients. The gastroenterologists’ mean appropriateness rating was 7.2 ± 1.7, and the panel’ s mean appropriateness rating was 5.4± 2.3 (P < 0.001). The percentages of indications rated inappropriate, uncertain, appropriate, and necessary were 4.1 23.8% , 14.2% , and 58.0% for the gastroenterologists and 27.2% , 26.7% , 25.0% , and 21.1% for the panel, respectively. Agreement between the two groups’ ratings was poor (28.8% , kappa=0.11). Differences between the two groups’ ratings decreased with increasing patient age, decreasing health status, and decreasing expertise level of the referring physician. However, the gastroenterologists produced consistently higher ratings. Conclusions: Compared with an expert panel, gastroenterologists tend to overestimate the appropriateness of colonoscopies they perform. Except for well-delineated reasons, participating gastroenterologists weighed patient characteristics differently from the panel when judging appropriateness. Ways to increase the prospective use of appropriateness criteria in order to improve appropriateness and reduce overuse of colonoscopies should be examined further.展开更多
文摘Background and Study Aims: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally. Patients and Methods: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. Results: 6004 patients were included in this study, of whom 53%received conscious/moderate sedation during colonoscopy, 30%received deep sedation, and 17%received no sedation. Sedation agents most commonly used were midazolam (47%) and opioids (33%). Pulse oximetry was done during colonoscopy in 77%of patients, blood pressure monitoring in 34%, and electrocardiography in 24%. Pulse oximetry was most commonly used for moderately sedated patients, while blood pressure monitoring and electrocardiography were used predominantly for deeply sedated patients. Sedation and monitoring use ranged from 0%to 100%between centers. Oxygen desaturation (≤85%) occurred in 5%of patients, of whom 80%were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27%of colonoscopies, and during 85%of colonoscopies using deep sedation. Conclusions: Internationally, sedation and monitoring practice during colonoscopy varied widely. Moderate sedation was the most common sedation method used and electronic monitoring was used in three-quarters of patients. Deep sedation tended to be more resource-intensive, implying a greater use of staff and monitoring.
文摘Background and study aim: Little is known about how gastroenterologists perceive the appropriateness of colonoscopies they perform. The objective of this study was to compare the appropriateness and necessity of colonoscopies as assessed by an expert panel and by the gastroenterologists performing the colonoscopies. Methods: This observational study included 21 centers in 11 countries. Patients referred for colonoscopy were consecutively included. Appropriateness and necessity of colonoscopies were independently rated on a 9-point scale by the gastroenterologists performing them and by an expert panel using a validated method (RAND). The differences between the ratings from the two groups were examined. Results: 6004 patients were included in the study. Comparisons of ratings were possible for 5381 (89.6% ) patients. The gastroenterologists’ mean appropriateness rating was 7.2 ± 1.7, and the panel’ s mean appropriateness rating was 5.4± 2.3 (P < 0.001). The percentages of indications rated inappropriate, uncertain, appropriate, and necessary were 4.1 23.8% , 14.2% , and 58.0% for the gastroenterologists and 27.2% , 26.7% , 25.0% , and 21.1% for the panel, respectively. Agreement between the two groups’ ratings was poor (28.8% , kappa=0.11). Differences between the two groups’ ratings decreased with increasing patient age, decreasing health status, and decreasing expertise level of the referring physician. However, the gastroenterologists produced consistently higher ratings. Conclusions: Compared with an expert panel, gastroenterologists tend to overestimate the appropriateness of colonoscopies they perform. Except for well-delineated reasons, participating gastroenterologists weighed patient characteristics differently from the panel when judging appropriateness. Ways to increase the prospective use of appropriateness criteria in order to improve appropriateness and reduce overuse of colonoscopies should be examined further.
