Su1432 SAFETY AND SEDATION-ASSOCIATED ADVERSE EVENT REPORTING AMONG PATIENTS UNDERGOING ENDOSCOPIC CHOLANGIOPANCREATOGRAPHY: A COMPARATIVE SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

While more than 500,000 endoscopic cholangiopancreatography (ERCP) procedures are performed annually in the United States, there remains wide variation in choice of sedation and airway management during the procedure. The primary aim of this study was to perform a comparative systematic review and meta-analysis to investigate safety outcomes of deep sedation with monitored anesthesia care (MAC) versus general endotracheal anesthesia (GETA). Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed in accordance with PRISMA and MOOSE guidelines. This meta-analysis was performed by calculating pooled proportions with rates estimated using random effects models. Baseline characteristics including the American Society of Anesthesiologists (ASA) physical status classification system and Mallampati score were included. Pooled proportions were calculated for measured outcomes including all-cause adverse events, anesthesia-associated adverse events (i.e., hypotension, cardiac arrhythmias, and hypoxemia). Post-procedure recovery time, conversion of MAC to GETA, and procedural success were also recorded. Only direct comparator studies of MAC versus GETA were included. Non-comparator studies were excluded. Heterogeneity was assessed with I2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. Five studies with a total of 1899 patients (MAC: n=1284 vs GETA: n=615) were included in this analysis. Patients that underwent GETA were younger, more commonly male, had a higher body mass index (BMI), and had a higher mean ASA score (all P<0.001). There was no difference in Mallampati scores (P=0.923). Procedure success was similar between MAC and GETA groups [(OR 1.16, 95% CI 0.51 to 2.64) – Table 1. Total adverse events and anesthesia-associated events were not different [OR 1.16 (95% CI, 0.29 to 4.70) and OR 1.33 (95% CI, 0.27 to 6.49)]. Compared to GETA, MAC resulted in fewer episodes of clinically significant hypotension [OR 0.32 (95% CI, 0.12 to 0.87], increased hypoxemic events [OR 5.61 (95% CI, 1.54 to 20.37)], and no difference in cardiac arrhythmias [OR 0.48 (95%, CI 0.13 to 1.78)] – Figure 1. Patients undergoing MAC were converted to GETA in 0.61% (95% CI, 0.18 to 0.21) of ERCP procedures. Mean procedure time was decreased for MAC though no difference in time to recovery from anesthesia [standard difference of -0.39 (95% CI, -0.78 to -0.00) and standard difference -0.49 (95% CI, -0.29 to 0.07]. Based upon this meta-analysis, MAC appears to be a safe strategy for patients undergoing ERCP; however, increased hypoxemic events were noted. While individual patient characteristics are pivotal to determine appropriate sedation, this study suggests MAC may be increasingly utilized as a safe alternative to GETA for individuals undergoing ERCP.View Large Image Figure ViewerDownload Hi-res image Download (PPT)