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. 2020 Feb 16;7(1):e000348.
doi: 10.1136/bmjgast-2019-000348. eCollection 2020.

Practice recommendations for the use of sedation in routine hospital-based colonoscopy

Fahima Dossa  1   2 , Catherine Dubé  3   4 , Jill Tinmouth  2   4   5 , Anne Sorvari  6 , Linda Rabeneck  4   5 , Bronwen R McCurdy  4 , Jason A Dominitz  7 , Nancy N Baxter  1   2   4   6
Affiliations

Practice recommendations for the use of sedation in routine hospital-based colonoscopy

Fahima Dossa et al. BMJ Open Gastroenterol. .

Abstract

Objective: Although sedation improves patient experience during colonoscopy, there is great jurisdictional variability in sedative practices. The objective of this study was to develop practice recommendations for the use of moderate and deep sedation in routine hospital-based colonoscopy to facilitate standardisation of practice.

Design: We recruited 32 multidisciplinary panellists to participate in a modified Delphi process to establish consensus-based recommendations for the use of sedation in colonoscopy. Panel members participated in a values assessment survey followed by two rounds of anonymous online voting on preliminary practice recommendations. An inperson meeting was held between voting rounds to facilitate consensus-building. Consensus was defined as >60% agreement/disagreement with recommendation statements; >80% agreement/disagreement was considered indicative of strong consensus.

Results: Twenty-nine panellists participated in the values assessment survey. Panellists ranked all factors presented as important to the development of practice recommendations. The factor considered most important was patient safety. Patient satisfaction, procedural efficiency, and cost were considered less important. Strong consensus was achieved for all nine practice recommendations presented to the panel. These recommendations included that all endoscopists be able to perform colonoscopy with moderate sedation, that an endoscopist and a single trained nurse are sufficient for performing colonoscopy with moderate sedation, and that anaesthesia-provided deep sedation be used for select patients.

Conclusion: The recommendations presented in this study were agreed on by a multidisciplinary group and provide guidance for the use of sedation in routine hospital-based colonoscopy. Standardised sedation practices will promote safe, effective, and efficient colonoscopy for all patients.

Keywords: colonoscopy; endoscopy; screening.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Consensus-building process.
Figure 2
Figure 2
Results of values assessment survey. Twenty-nine members of the expert panel participated in the values assessment survey. Panel members were provided with a list of 20 factors/outcomes and were asked to provide a score (1–10) indicating the importance of the factor in the generation of practice recommendations.
See this image and copyright information in PMC

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