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 23 February 2018

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News

Use of unsedated endoscopy and propofol in practice

Unsedated endoscopy does not have a great impact on endoscopic screening in the US, although propofol sedation has gained acceptance in the community, finds the latest issue of Gastrointestinal Endoscopy.

News image

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There have been lower reimbursements for endoscopic procedures and increasing demand for screening endoscopy over the past decade.

This has spurred efforts to increase efficiency in the performance of endoscopic procedures.

Two dichotomous approaches have emerged, which include unsedated endoscopy and propofol sedation.

Dr Ashley Faulx and colleagues determined national practice patterns of unsedated endoscopy and propofol sedation.

45% do not routinely offer unsedated esophagogastroduodenoscopy and colonoscopy
Gastrointestinal Endoscopy

The researchers assessed endoscopists' attitudes toward unsedated screening with an electronic survey.

The research team developed a short survey, which was then converted to a Web-based format.

All national members of the American Society for Gastrointestinal Endoscopy were invited via electronic mail to participate.

The researchers collected survey data electronically.

The research team reported that 2 e-mails elicited responses to the Web survey from 18% of members contacted, within 2 weeks.

Of the respondents, the team found that 45% do not routinely offer unsedated esophagogastroduodenoscopy and colonoscopy.

The team also found that only 15% of those respondents planned to incorporate unsedated endoscopy into their practice in the next year.

Of the 55% who currently perform unsedated endoscopy, the team noted that 85% do no more than 25 unsedated procedures per year.

The researchers found that lack of patient acceptance was the most common reason cited for not offering unsedated endoscopy.

Most endoscopists felt that the availability of unsedated esophagoscopy would not significantly increase screening for Barrett's esophagus.

The team also noted that most endoscopists thought unsedated colonscopy would not increase screening for colonic polyps or colorectal cancer.

The team observed that 19% reported routine use of propofol sedation for esophagogastroduodenoscopy, and 22% routinely used colonoscopy.

The researchers reported that endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography was routinely used by 19%.

Community practitioners were more likely to use propofol than those at academic centers.

Of those not currently using propofol, the team found that 43% plan to incorporate it into their practice within the next year.

In addition, the researchers noted that over 70% of respondents would themselves choose to be sedated for routine endoscopic procedures.

Dr Faulx's team concluded, “Electronic surveys allow for rapid distribution and data collection but suffer from a limited response rate.”

“The survey suggests that unsedated endoscopy has limited acceptance in the United States.”

“Without a major intervention that affects endoscopists' attitudes, its use is not likely to increase significantly.”

“Unsedated endoscopy will not have a great impact on endoscopic screening.”

“In contrast, propofol sedation has already gained acceptance in the community, and the routine use of propofol in endoscopy units will likely increase in the future.”

Gastrointest Endosc 2005: 62(1): 9
11 July 2005

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