Endoscopic Sedation in the United States in 2004: Results From a Postal Survey of 5000 Gastroenterologists

Abstract

Background: The introduction of new sedative agents and a desire for greater efficiency during endoscopy have contributed to changes in the practice of endoscopic sedation in the United States (US). However, sedation practices have not been surveyed since 1990 (Gastrointest Endosc 1990;36:S13-S18). The aim of this study was to define current practice patterns of endoscopic sedation within the US. Methods: A 23-question survey pertaining to endoscopic sedation was created, refined by a consultant, and then mailed during 07/04 to 5,000 randomly-selected ACG physician members. A follow-up “reminder” was sent 6 weeks later. Proportional geographic representation of the ACG membership was preserved by dividing the US into 6 regions for mailings. Results: 1353 questionnaires (27%) were returned. 60% of respondents were between the ages of 30 and 49. 33% were in practice 0-9 years, 33% 10-19 years, and 33% > 19 years. 21% were in academic practice, 19% in solo practice, and 60% in group practice. 55% of endoscopies were performed in a hospital (range 0-100%), 36% in an ambulatory center (0-100%) and 9% in an office (0-100%). Respondents performed an average of 12 EGDs and 22 colonoscopies (CL) per week, and 99% of all endoscopies were performed with sedation. Supplemental O2 was routinely administered by 66% and 89% of respondents using conventional and propofol sedation, respectively. Monitoring of vital signs (99%) and pulse oximetry (99%) was standard, but only 3% of respondents used capnography. 75% of respondents used narcotic/benzodiazepine sedation exclusively, while 25% used propofol for some or all exams. The use of propofol varied by geographic region, ranging from 2% (northeastern states) to 43% (mid-Atlantic states) of providers. 38% of gastroenterologists utilized an anesthesiologist to administer propofol, 16% a CRNA, 33% a combination of the two, and 8% administered propofol themselves. Endoscopist satisfaction was greater with propofol than conventional sedation (9.0/10 vs. 8.2/10, p < 0.0001). 48% of endoscopists would choose propofol for their own CL, 39% conventional sedation, and 12% no sedation. Conclusions: 1. Propofol is used by about one-quarter of all endoscopists nationwide although this rate varies by region of the country. 2. Physician satisfaction scores for sedation are higher among users of propofol than conventional sedation drugs, and 3. More endoscopists would choose propofol than conventional sedation for their own exam. Background: The introduction of new sedative agents and a desire for greater efficiency during endoscopy have contributed to changes in the practice of endoscopic sedation in the United States (US). However, sedation practices have not been surveyed since 1990 (Gastrointest Endosc 1990;36:S13-S18). The aim of this study was to define current practice patterns of endoscopic sedation within the US. Methods: A 23-question survey pertaining to endoscopic sedation was created, refined by a consultant, and then mailed during 07/04 to 5,000 randomly-selected ACG physician members. A follow-up “reminder” was sent 6 weeks later. Proportional geographic representation of the ACG membership was preserved by dividing the US into 6 regions for mailings. Results: 1353 questionnaires (27%) were returned. 60% of respondents were between the ages of 30 and 49. 33% were in practice 0-9 years, 33% 10-19 years, and 33% > 19 years. 21% were in academic practice, 19% in solo practice, and 60% in group practice. 55% of endoscopies were performed in a hospital (range 0-100%), 36% in an ambulatory center (0-100%) and 9% in an office (0-100%). Respondents performed an average of 12 EGDs and 22 colonoscopies (CL) per week, and 99% of all endoscopies were performed with sedation. Supplemental O2 was routinely administered by 66% and 89% of respondents using conventional and propofol sedation, respectively. Monitoring of vital signs (99%) and pulse oximetry (99%) was standard, but only 3% of respondents used capnography. 75% of respondents used narcotic/benzodiazepine sedation exclusively, while 25% used propofol for some or all exams. The use of propofol varied by geographic region, ranging from 2% (northeastern states) to 43% (mid-Atlantic states) of providers. 38% of gastroenterologists utilized an anesthesiologist to administer propofol, 16% a CRNA, 33% a combination of the two, and 8% administered propofol themselves. Endoscopist satisfaction was greater with propofol than conventional sedation (9.0/10 vs. 8.2/10, p < 0.0001). 48% of endoscopists would choose propofol for their own CL, 39% conventional sedation, and 12% no sedation. Conclusions: 1. Propofol is used by about one-quarter of all endoscopists nationwide although this rate varies by region of the country. 2. Physician satisfaction scores for sedation are higher among users of propofol than conventional sedation drugs, and 3. More endoscopists would choose propofol than conventional sedation for their own exam.