S1109 General vs Monitored Anesthesia Time: Is One Preferred for EUS-Guided Portal Pressure Gradient Measurements and Liver Biopsies?

Abstract

Introduction: EUS-guided portal pressure gradient (PPG) measurement and EUS guided liver biopsies are well tolerated procedures under anesthesia, but it is unclear which anesthesia modality, monitored anesthesia care (MAC) or general anesthesia (GA), is superior for performing these cases. We aimed to describe our centers’ experiences and approach to EUS-guided PPG and liver biopsy from an anesthesia perspective and compared the two anesthesia modalities in terms of procedure duration, efficacy, and safety. Methods: This was a retrospective review of all consecutive patients who underwent EUS-guided PPG measurement and/or liver biopsies at a single tertiary center between June 2021 and May 2022. All procedures were done with an anesthesiologist attending and/or a resident/nurse. After initial experience with GA, our center largely switched to MAC for these cases. In the last 40 cases, 82% were done with MAC. Demographic data, scope time, anesthesia time, technical success rate, and adverse events post procedure for each patient were noted. Statistical analysis was performed using student t-testing. Results: We have a total of 73 patients who underwent EUS guided PPG measurement and/or liver biopsy, with 30 (54%) having undergone only PPG measurement. The mean age was 51, with 56 (77%) patients being female and mean BMI as 37. The clinical indication for most patients 60 (82%) in undergoing the EUS procedure was for evaluation of underlying NAFLD/NASH. No differences in basic demographics was found between the MAC and GA cohorts. The mean scope time for MAC vs GA was 38.2 ± 14.2 and 47.3 ± 14.5 minutes respectively for patients who underwent both EUS-PPG and liver biopsy. The timing of endoscopy was comparable between the two modalities (p=0.013). The mean anesthesia time for MAC vs GA was 57.1 ± 14.9 and 81.6 ± 14.9 minutes respectively, with MAC being shorter by 25 minutes (p= < 0.001). Similar comparisons were made for patients who underwent EUS-PPG alone. Technical success was 100% for all cases, and there was only one reported adverse event of a patient who reported transient shortness of breath post-extubation from GA who underwent EUS-PPG alone. This was resolved within a few hours with close monitoring. (Table) Conclusion: Our results show that MAC was superior in terms of anesthesia time as compared to GA. Both anesthesia modalities demonstrated excellent and comparable safety and efficacy. Table 1. - Procedure and Anesthesia time for EUS guided PPG measurement and Liver Biopsy Table a EUS guided PPG measurement (with liver biopsy) Mean Mac(n=20) GA (N=23) p value Procedure time (mins) 38.2 ± 14.2 47.3 ± 14.5 0.013 Anesthesia time (mins) 57.1 ± 14.9 81.6 ± 14.9 Table b EUS guided PPG measurement (without liver biopsy) Mean MAC (N=13) GA (N=17) p value Procedure time (mins) 37.7 ± 14.5 46.9 ± 14.5 0.011 Anesthesia time (mins) 58.1 ± 15.5 81.9 ± 15.5 < 0.001 Table c Mean intubation time with GA (n=23 )( with liver biopsy) 66.3 ± 14.6 Mean intubation time in minutes with GA (n= 17) ( without liver biopsy) 66 ± 15.3