Tu1063 THE EFFECT OF SEDATION MODALITY ON OUTCOMES OF EMERGENT ENDOSCOPIC INTERVENTION

Abstract

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), monitored anesthesia care (MAC) and general anesthesia (GA). Using Current Procedural Terminology codes, we conducted a single-center retrospective chart review of all patients presenting with acute FBI between 2010 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. Among the 376 encounters analyzed, 174 encounters (46.3%) were performed under CS, 84 encounters (22.3%) under MAC and the rest (31.4%) under GA. The median age of the subjects was 53 years old, with 70.5% being male. A total of 49 subjects (13.0%) had severe comorbidities and 18.4% had psychiatric disorders. The majority of the encounters (73.5%) were food bolus impaction with the rest being foreign body ingestion (26.5%). The most commonly observed early complications were bleeding (3.5%) and mucosal laceration (2.4%). The most common delayed complication was aspiration pneumonia (1.3%). A total of 13 patients (7.5%) could not adequately be sedated with CS and had to be converted to MAC or GA. Patient sedated with GA were more likely to require hospitalization (p <0.0001). Chi-square analysis, however, revealed no statistically significant difference in the complication rate between patients sedated under CS (13.8%), MAC (17.9%) and GA (17.0%), p= 0.63. 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 CS, MAC and GA. This finding may potentially lead to lower procedure-related costs and length of hospital stay.View Large Image Figure ViewerDownload Hi-res image Download (PPT)