[How safe is premedication in ambulatory endoscopy in Germany? A prospective study in gastroenterology specialty practices]

Abstract

Background: To date there is no prospective large-scale study of the risk of premedication on the complication rate of outpatient gastrointestinal endoscopy in Germany.

Patients and methods: In 67 gastroenterological practises in Germany the number of esophagogastroduodenoscopies (EGD) and colonoscopies was recorded from april 1998 until march 1999. All serious complications had to be recorded in a structured protocol.

Results: The overall complication rate for EGD (n = 110,469) was low (0.009%) and about two third of the adverse effects were due to premedication (0.006%). The overall complication rate for diagnostic colonoscopy (n = 82,416) was 0.02% and the complication rate associated to premedication was 0.01%. An individual dosage of premedication for EGD and colonoscopy was given by all gastroenterologists. Most of the gastroenterologists applied premedication in 10 to 50 percent of the patients for EGD and in 70 to 100 percent of the patients for colonoscopy. Most of the cardiorespiratory adverse effects in colonoscopy occurred if sedation was performed by combination of benzodiazepines and opioids and in upper gastrointestinal endoscopy with high dosages of diazepam. In 6 of 45 practises disoprivan (propofol) was used for premedication in 2-50 percent of the colonoscopies. Two of four perforations in diagnostic colonoscopy occurred under sedation with disoprivan.

Conclusions: Outpatient gastrointestinal endoscopy performed by German gastroenterologists in a safe. The complication rate is low compared to the international literature and could be further decreased by avoiding a combination of benzodiazepines and opioids for sedation in colonoscopy and high dosages of diazepam in upper gastrointestinal endoscopy.