529 The Effect of Sedation Modality on Outcomes in Emergent Endoscopic Intervention

Abstract

INTRODUCTION: Foreign body ingestion and food bolus impaction (FBI) are common indications for emergent endoscopic intervention. The choice of sedation used is often dictated by physician experience. There is paucity of data examining the efficacy and safety of general anesthesia versus conscious sedation in this population. This study aims to investigate the outcomes and complication rates of emergent endoscopic extrication of foreign body/food bolus performed under conscious sedation (CS) compared to general anesthesia (GA). METHODS: Using ICD-9 and ICD-10 codes, we conducted a single-center retrospective chart review of all patients presenting with acute FBI between 2013 and 2018. Data on demographics, comorbidities, endoscopic details and sedation practices were collected. Complications recognized during the procedure were considered early whereas patients presenting with a procedure-related complication within two weeks of the index event were considered delayed complications. Chi-square analysis was used to compare groups based on sedation type. Results were considered statistically significant at P < 0.05. RESULTS: Among the 223 encounters analyzed, 133 encounters (59.6%) were performed under general anesthesia or monitored anesthesia care, with the rest (40.4%) under conscious sedation. The median age of the subjects was 52 years old, with 70.5% being male. A total of 27 subjects (12.1%) had severe comorbidities and 21.9% had psychiatric disorders. The majority of the encounters (73.7%) were food bolus impaction with the rest being foreign body ingestion (26.3%). The most commonly observed early complications were mucosal laceration (8.5%) and bleeding (4.0%). The most common delayed complication was abdominal pain (1.3%). Five patients could not adequately be sedated with CS and had to be converted to GA. Chi-square analysis revealed no statistically significant difference in the complication rate between patients sedated under GA (18.1%) vs CS (14.4%), P = 0.48. CONCLUSION: For patients who present with foreign body ingestion or food bolus impaction and undergo emergent endoscopic treatment, there is no significant difference in complication rates between general anesthesia and conscious sedation. This finding may potentially lead to lower procedure-related costs and length of hospital stay.