A prospective study on incidence of desaturations in ERCP with non-anesthesiologist sedation and adverse event awareness of endoscopists

Abstract

Little is known of the desaturation rate among NAPS (non-anesthesiological/nurse-administered propofol-sedation) ERCPs (endoscopic retrograde cholangiopancreatography) and endoscopists` awareness of overall incidence of adverse events (AEs). The primary aims were to assess desaturation rates and endoscopists` AE-awareness. In this prospective observation study, all ERCPs performed in a certain period were included. Nurses documented hypoxemia and measures taken to correct it. Charts were reviewed for clinical data. Definitions of AEs were based on the 2020 ESGE guidelines. Of 232 included ERCPs, 218 (94%) were conducted using NAPS. Mean age was 67.9 (SD 15.8) years, 53.2% were female, median ASA status was 2 (IQR 2;3). Most (86.8%) procedures were started on 2 L O2 flow/min (via nasal cannula), propofol mono-sedation was used in 98.2%. A desaturation occurred in 22.6% (n = 45) of procedures, and 28.1% (n = 56), when including interventions performed for hypoxemia. Risk factors for desaturations were higher BMI, and higher ASA status (p < 0.05). Documentation of AEs by endoscopists was exceptionally low. Only 22.2% of post-ERCP pancreatitis, 19% of intraprocedural bleeding, 20% of desaturations were officially recorded/documented. All-cause 30-day mortality was significantly higher in the desaturation group (10.7% vs. 2.8%, p = 0.03). Sedation-AEs are common and desaturation is statistically significantly associated with 30-day-mortality. Incidence of complications is underappreciated by endoscopists.

Keywords: Adverse events; ERCP; Endoscopic retrograde cholangiopancreatography; Hypoxemia; Nurse-administered propofol sedation (NAPS); Sedation-related complications.

Fig. 1

Desaturation and association with mortality. Left side incidences of desaturation (dotted filled) and interventions for hypoxemia (dashed filled); right side mortality of patients without hypoxemic events (unfilled) and with hypoxemic events (dashed filled); means with 95% CIs; * =  p < 0.05.

Fig. 2

Parameters statistically significantly (p < 0.05) associated with interventions for hypoxemia in univariable analysis; upper left graph weight in kg of patients with hypoxemia (filled dots), and without (grey dots) with mean and 95%CI; upper right graph BMI (kg/m²) of patients with hypoxemia (filled dots), and without (grey dots) with mean and 95%CI; lower left graph proportion of patients with hypoxemia according to ASA status (note: very patients with ASA 1); lower right graph proportion of patients with hypoxemia according to snoring as reported by the patient (note: few patients with unknown status).

Fig. 3

Proportion of patients with any cardiorespiratory adverse event according to ASA status (hypotension, hypertension, hypoxemia, cardiopulmonary resuscitation, 30-day all-cause mortality – any one of those), chi-squared test p = 0.012.