S0940 Safety of Patient Controlled Sedation in Endoscopic Retrograde Cholangiopancreatography: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Monitored anesthesia care (MAC) and general anesthesia care are two common methods of sedation used for endoscopic retrograde cholangiopancreatography (ERCP). Patient controlled sedation (PCS) is another modality of anesthesia, which allows the patient to control their own level of sedation at the touch of a button. We performed a systematic review and meta-analysis to evaluate the overall safety of patient controlled sedation. METHODS: We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Web of Science, Google Scholar and manual search of references (from inception through Jan 2020) to identify any studies reporting use of PCS as choice of sedation for ERCP. The primary outcome was to evaluate the success of anesthesia defined as successful procedure under PCS. The secondary outcomes evaluated sedation related adverse events (AE) and correlation of American Society of Anesthesiologists classification (ASA) with the number of AE. This meta-analysis was performed using Der Simonian and Laird random effect model. RESULTS: A total of 7 studies reported on 848 patients. The mean age was 53 and majority of the population were male. ERCP was successful in 86% (95% CI = 0.76–0.96, I2 = 94%) of the patients. The overall sedation related AE were 13.56% (95% CI = 0.11–0.15). Our sub-group analysis showed rates of hypoxia at 7.9% (95% CI = 0.06–0.09), hypotension at 2.71% (95% CI = 0.02–0.04), over sedation at 2% (95% CI = 0.00–0.03), aspiration pneumonia at 0.83% (95% CI = 0.00–0.02), arrhythmia at 0.12% (95% CI = 0.00–0.005), and no other sedation related AE. ASA correlation with number of AE was done with classes I–III. ASA class III had moderate positive correlation to hypoxia with an r value of 0.4 and was statistically significant. Significant heterogeneity was noted in our analysis. CONCLUSION: In our meta-analysis, PCS could be a safe alternative anesthesia for ERCP. Hypoxia was the most common AE observed from PCS and has moderate positive correlation with ASA class III. Further large multicenter randomized controlled trials are needed to validate these findings.Figure 1.: ERCP success rates under patient controlled sedation.