Consensus on the Management of Anesthetic Agents During Digestive Motility Measurements and Proposal of a Standardized Protocol for Anesthesia (French Neuro Gastroenterology Group GFNG and Committee of Anesthetic French Experts)

Domitille Renard¹, Thomas Clavier^{1

2}, Osama Abou-Arab³, Gérard Amarenco⁴, Emmanuel Besnier^{1

2}, Alice Blet⁵, Matthieu Boisson⁶, Charlène Brochard^{7

8}, Benoit Coffin⁹, Audrey De Jong¹⁰, Denis Frasca¹¹, Marc Garnier¹², Aurelie Gouel¹³, Jérémie Jacques¹⁴, Arthur James^{15

16}, Yoann Launey¹⁷, Anne-Marie Leroi¹⁸, Chloé Melchior¹⁹, Daphné Michelet²⁰, François Mion²¹, Maxime Nguyen²², Emmanuel Rineau²³, Amélie Rollé²⁴, Sabine Roman²¹, Stéphanie Sigaut²⁵, Heithem Soliman⁹, Fabien Wuestenberghs^{26

27}, Frank Zerbib²⁸, Guillaume Gourcerol¹⁸, Charlotte Desprez¹⁸

Affiliations

¹ Department of Anesthesiology, Critical Care and Perioperative Medecine, CHU Rouen, Rouen, France.
² Univ Rouen Normandie, INSERM U1096, EnVI, Rouen, France.
³ Anesthesiology, Critical Care Medecine and Perioperative Medecine Department, Amiens University Hospital, Amiens, France.
⁴ Sorbonne Université, GRC n°1, Groupe de Recherche Clinique en Neuro-Urologie - GREEN, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France.
⁵ Department of Anaesthesiology and Critical Care, IHU EVEREST, Croix Rousse University Hospital, Hospices Civils de Lyon, INSERM U1052, Cancer Research Center of Lyon, University Lyon 1, Lyon, France.
⁶ Université de Poitiers, INSERM, PHAR2, CHU de Poitiers Service d'Anesthésie Réanimation Médecine Péri-opératoire, Poitiers, France.
⁷ Diseases of the Digestive Tract Department, Functional Digestive Explorations Division, Pontchaillou University Hospital, Rennes University, Rennes, France.
⁸ INSERM U1235, Nantes University, Nantes, France.
⁹ Université de Paris Cité, Département d'Hépato-Gastro-Entérologie, Hôpital Louis Mourier, DMU ESPRIT AP-HP Nord, Colombes, France.
¹⁰ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, Montpellier University Hospital, St-Eloi Hospital, INSERM U1046, CNRS UMR, PhyMedExp, University of Montpellier, Montpellier, France.
¹¹ CHU de Poitiers, INSERM CIC1402, Université de Poitiers, Poitiers, France.
¹² Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, AP-HP Tenon Hospital, Paris, France.
¹³ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, AP-HP Hospital, Paris, France.
¹⁴ Hepatogastroenterology Department, Limoges University Hospital, Limoges, France.
¹⁵ Sorbonne Université, GRC 29, Groupe de Recherche Clinique en Anesthésie Réanimation médecine Périopératoire, ARPE, Paris, France.
¹⁶ Department of Anesthesiology and Critical Care, APHP, Hôpital La Pitié Salpêtrière, DMU DREAM, Paris, France.
¹⁷ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, Rennes University Hospital, Rennes, France.
¹⁸ Department of Digestive Physiology, ADEN UMR1073, Nutrition, Inflammation and Microbiota-Gut-Brain Axis, CHU Rouen, CIC-CRB 1404, Univ Rouen Normandie, INSERM, Normandie Univ, Rouen, France.
¹⁹ Department of Gastroenterology, Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR1073, Nutrition, Inflammation and Microbiota-Gut-Brain Axis, CHU Rouen, Rouen, France.
²⁰ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, Reims University Hospital, C2S Laboratory, Reims Champagne Ardenne University, Reims, France.
²¹ Digestive Physiology Department, Hospices Civils de Lyon, INSERM, LabTAU, Lyon University, Lyon, France.
²² Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, INSERM U1231, Dijon Hospital University, Dijon, France.
²³ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, Angers University Hospital, Angers, France, Univ Angers, MITOVASC Inserm U1083 - CNRS 6015, Team CARME, Angers, France.
²⁴ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, Guadeloupe University Hospital, French Caribbean, France.
²⁵ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, AP-HP Beaujon Hospital, Paris, France.
²⁶ Department of Gastroenterology and Digestive Oncology, Sorbonne Paris Nord University, Hôpital Avicenne, AP-HP, Bobigny, France.
²⁷ AgroParisTech, INRAe, UMR 914 PNCA Physiologie de la Nutrition et du Comportement Alimentaire, Université Paris-Saclay, Palaiseau, France.
²⁸ Bordeaux University Hospital, Centre Medico-Chirurgical Magellan, Haut-Lévêque Hospital and Gastroenterology Department, Bordeaux University, INSERM CIC, Bordeaux, France.

PMID: 40528713
DOI: 10.1111/nmo.70098

Consensus on the Management of Anesthetic Agents During Digestive Motility Measurements and Proposal of a Standardized Protocol for Anesthesia (French Neuro Gastroenterology Group GFNG and Committee of Anesthetic French Experts)

Domitille Renard et al. Neurogastroenterol Motil. 2025.

. 2025 Jun 18:e70098.

doi: 10.1111/nmo.70098. Online ahead of print.

Authors

Affiliations

¹ Department of Anesthesiology, Critical Care and Perioperative Medecine, CHU Rouen, Rouen, France.
² Univ Rouen Normandie, INSERM U1096, EnVI, Rouen, France.
³ Anesthesiology, Critical Care Medecine and Perioperative Medecine Department, Amiens University Hospital, Amiens, France.
⁴ Sorbonne Université, GRC n°1, Groupe de Recherche Clinique en Neuro-Urologie - GREEN, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France.
⁵ Department of Anaesthesiology and Critical Care, IHU EVEREST, Croix Rousse University Hospital, Hospices Civils de Lyon, INSERM U1052, Cancer Research Center of Lyon, University Lyon 1, Lyon, France.
⁶ Université de Poitiers, INSERM, PHAR2, CHU de Poitiers Service d'Anesthésie Réanimation Médecine Péri-opératoire, Poitiers, France.
⁷ Diseases of the Digestive Tract Department, Functional Digestive Explorations Division, Pontchaillou University Hospital, Rennes University, Rennes, France.
⁸ INSERM U1235, Nantes University, Nantes, France.
⁹ Université de Paris Cité, Département d'Hépato-Gastro-Entérologie, Hôpital Louis Mourier, DMU ESPRIT AP-HP Nord, Colombes, France.
¹⁰ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, Montpellier University Hospital, St-Eloi Hospital, INSERM U1046, CNRS UMR, PhyMedExp, University of Montpellier, Montpellier, France.
¹¹ CHU de Poitiers, INSERM CIC1402, Université de Poitiers, Poitiers, France.
¹² Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, AP-HP Tenon Hospital, Paris, France.
¹³ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, AP-HP Hospital, Paris, France.
¹⁴ Hepatogastroenterology Department, Limoges University Hospital, Limoges, France.
¹⁵ Sorbonne Université, GRC 29, Groupe de Recherche Clinique en Anesthésie Réanimation médecine Périopératoire, ARPE, Paris, France.
¹⁶ Department of Anesthesiology and Critical Care, APHP, Hôpital La Pitié Salpêtrière, DMU DREAM, Paris, France.
¹⁷ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, Rennes University Hospital, Rennes, France.
¹⁸ Department of Digestive Physiology, ADEN UMR1073, Nutrition, Inflammation and Microbiota-Gut-Brain Axis, CHU Rouen, CIC-CRB 1404, Univ Rouen Normandie, INSERM, Normandie Univ, Rouen, France.
¹⁹ Department of Gastroenterology, Univ Rouen Normandie, INSERM, Normandie Univ, ADEN UMR1073, Nutrition, Inflammation and Microbiota-Gut-Brain Axis, CHU Rouen, Rouen, France.
²⁰ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, Reims University Hospital, C2S Laboratory, Reims Champagne Ardenne University, Reims, France.
²¹ Digestive Physiology Department, Hospices Civils de Lyon, INSERM, LabTAU, Lyon University, Lyon, France.
²² Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, INSERM U1231, Dijon Hospital University, Dijon, France.
²³ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, Angers University Hospital, Angers, France, Univ Angers, MITOVASC Inserm U1083 - CNRS 6015, Team CARME, Angers, France.
²⁴ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, Guadeloupe University Hospital, French Caribbean, France.
²⁵ Anesthesiology, Critical Care Medicine and Perioperative Medicine Department, AP-HP Beaujon Hospital, Paris, France.
²⁶ Department of Gastroenterology and Digestive Oncology, Sorbonne Paris Nord University, Hôpital Avicenne, AP-HP, Bobigny, France.
²⁷ AgroParisTech, INRAe, UMR 914 PNCA Physiologie de la Nutrition et du Comportement Alimentaire, Université Paris-Saclay, Palaiseau, France.
²⁸ Bordeaux University Hospital, Centre Medico-Chirurgical Magellan, Haut-Lévêque Hospital and Gastroenterology Department, Bordeaux University, INSERM CIC, Bordeaux, France.

PMID: 40528713
DOI: 10.1111/nmo.70098

Abstract

Introduction: Techniques for measuring digestive motility are becoming increasingly precise and enable therapeutic interventions. However, while most of these interventions require general anesthesia, there is limited data on the impact of anesthetic agents on these measurements, and no standardized anesthesia protocol currently exists to guide such procedures. Our working group carried out two Delphi processes involving experts in neurogastroenterology and anesthesiology to reach a consensus on which drugs affect these measurements and to establish an anesthesia protocol.

Method: Two expert groups were formed, comprising 13 neurogastroenterology experts from the French Neuro-Gastroenterology Group (GFNG) and 15 full- or associate professors in anesthesia and intensive care. The first Delphi process involved the neurogastroenterologists and aimed to identify which anesthetic drugs influenced digestive pressure measurements. The second Delphi process, involving anesthetists, sought to develop an anesthesia protocol. Each expert indicated their level of agreement with each statement using a 6-point Likert scale. A statement was endorsed when at least 80% of experts agreed with it. The strength of evidence for each statement was evaluated using the GRADE system.

Results: The Delphi process with neurogastroenterologists was conducted over three rounds and ultimately resulted in 91 amendments. The second Delphi process with anesthetists took place over two rounds and included 28 amendments, leading to the development of an anesthesia protocol.

Conclusion: To our knowledge, this work is the first to establish an expert consensus on anesthetic agents that can affect digestive motility measurements and to propose an anesthesia protocol that accounts for the needs of neurogastroenterologists.

Keywords: Delphi; FLIP; anesthesia protocol; digestive motility; experts groups; manometry.

PubMed Disclaimer

References

1. C. Desprez, S. Roman, A. M. Leroi, and G. Gourcerol, “The Use of Impedance Planimetry (Endoscopic Functional Lumen Imaging Probe, EndoFLIP) in the Gastrointestinal Tract: A Systematic Review,” Neurogastroenterology and Motility 32, no. 9 (2020): e13980.
1. R. Yadlapati, P. J. Kahrilas, M. R. Fox, et al., “Esophageal Motility Disorders on High‐Resolution Manometry: Chicago Classification Version 4.0,” Neurogastroenterology and Motility 33, no. 1 (2021): e14058.
1. H. Soliman and G. Gourcerol, “Targeting the Pylorus in Gastroparesis: From Physiology to Endoscopic Pyloromyotomy,” Neurogastroenterology and Motility 35, no. 2 (2023): e14529.
1. B. L. A. M. Weusten, M. Barret, A. J. Bredenoord, et al., “Endoscopic Management of Gastrointestinal Motility Disorders – Part 1 | ESGE,” [cité 17 sept 2024], Endoscopy 52, no. 6 (2020): 498–515, https://doi.org/10.1055/a‑1160‑5549.
1. E. V. Carrington, H. Heinrich, C. H. Knowles, et al., “The International Anorectal Physiology Working Group (IAPWG) Recommendations: Standardized Testing Protocol and the London Classification for Disorders of Anorectal Function,” Neurogastroenterology and Motility 32, no. 1 (2020): e13679.

LinkOut - more resources

Full Text Sources
- Wiley

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Consensus on the Management of Anesthetic Agents During Digestive Motility Measurements and Proposal of a Standardized Protocol for Anesthesia (French Neuro Gastroenterology Group GFNG and Committee of Anesthetic French Experts)

Affiliations

Consensus on the Management of Anesthetic Agents During Digestive Motility Measurements and Proposal of a Standardized Protocol for Anesthesia (French Neuro Gastroenterology Group GFNG and Committee of Anesthetic French Experts)

Authors

Affiliations

Abstract

References

LinkOut - more resources

Full Text Sources