General anaesthesia safe for ERCP in average-risk patients, finds study

Saudi Arabia: General anesthesia (GA) is safe with fewer sedation-related adverse events (SRAE) than monitored anesthesia care (MAC) in patients with ASA scores ≤3 undergoing endoscopic retrograde cholangiopancreatography (ERCP), reported an article published in the Gastrointestinal Endoscopy.

ERCP is a complex procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. ERCP procedure is very uncomfortable and so requires adequate sedation or general anesthesia for its successful termination. General anesthesia (GA) or monitored anesthesia care (MAC) is increasingly used to perform endoscopic retrograde cholangiopancreatography (ERCP). The definitive choice between the two sedative types remains to be established. ERCP is often performed in patients at high risk for sedation-related adverse events. The ASA (American Society of Anesthesiology) score is a metric to determine if someone is healthy enough to tolerate surgery and anesthesia.

Adnan Baraka A, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia, and colleagues compared the outcome of GA with MAC in ERCP performed in patients at average risk for sedation-related adverse events.

Researchers randomly assigned 204patients (ASA class ≤3 ) to undergo ERCP with MAC or GA at a tertiary referral center. The main outcome was a composite of hypotension, arrhythmia, hypoxia, hypercapnia, apnea, and procedural interruption/termination that was defined as sedation-related adverse events (SRAE). Researchers also compared ERCP procedural time, success, and adverse events including endoscopist and patient satisfaction.

Results:

• Out of all patients,203 were evaluated for SRAE (MAC, n=96; GA, n=107).

• SRAE developed in 35% (34/96) in MAC versus 9% (10/107) in GA, which was statistically significant.

• ERCP procedure time, recovery time, cannulation time/success and procedure-related adverse events were not statistically different between the two sedative groups.

• Although GA had a significantly longer mean induction time, endoscopist and patient satisfaction were higher for GA.

Researchers concluded that GA is safe with fewer SRAE than MAC in patients with ASA scores ≤3 undergoing ERCP as compared to MAC. Apart from prolonging induction time, the use of GA does not change the procedural success or ERCP-related complications and offers greater endoscopist/patient satisfaction.

General anesthesia is thus associated with higher endoscopist/patient satisfaction and fewer sedation-related adverse events and should be considered in patients undergoing ERCP, the authors suggested.

Reference:

Alzanbagi AB, Jilani TL, Qureshi LA, Ibrahim IM, Saeed Tashkandi AM, Ali Elshrief EE, Khan MS, Hafez Abdelhalim MA, Zahrani SA, Kamel Mohamed WM, Nageeb AM, Abbushi B, Shariff MK. Randomized trial comparing general anesthesia with anesthesiologist administered deep sedation for ERCP in average-risk patients. Gastrointest Endosc. 2022 Jun 8:S0016-5107(22)01739-4. doi: 10.1016/j.gie.2022.06.003. Epub ahead of print. PMID: 35690151