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World J Gastroenterol. Aug 14, 2026; 32(30): 122191
Published online Aug 14, 2026. doi: 10.3748/wjg.122191
Risk of respiratory complications following gastrointestinal endoscopy under monitored anesthesia care: A prospective cohort study
Li-Xia Ma, Li-Na Zhang, You-Zhuang Zhu, Meng-Han Wang, Xue-Bin Du, Li-Jie Qi, Jian Sun, Xuan-Long Yi, Pei Wang, Zan-Gong Zhou, Xiang-Yu Ji, Lei Zhang
Li-Xia Ma, You-Zhuang Zhu, Xue-Bin Du, Li-Jie Qi, Jian Sun, Xuan-Long Yi, Pei Wang, Zan-Gong Zhou, Xiang-Yu Ji, Lei Zhang, Department of Anesthesiology, Shandong Provincial Key Medical and Health Laboratory of Anesthesia and Brain Function, The Affiliated Hospital of Qingdao University, Qingdao 266100, Shandong Province, China
Li-Na Zhang, Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao 266075, Shandong Province, China
Meng-Han Wang, Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Meng-Han Wang, Department of Gastroenterology, State Key Laboratory of Digestive Health, Beijing 100050, China
Meng-Han Wang, Department of Gastroenterology, National Clinical Research Center for Digestive Disease, Beijing 100050, China
Meng-Han Wang, Department of Gastroenterology, Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing 100050, China
Co-first authors: Li-Xia Ma and Li-Na Zhang.
Co-corresponding authors: Xiang-Yu Ji and Lei Zhang.
Author contributions: Ma LX and Zhang LN drafted the manuscript as co-first authors; Ma LX, Zhang LN, Zhu YZ, Du XB, Qi LJ, Sun J, Yi XL, Wang P, Zhou ZG, and Ji XY collected the data; Ma LX, Zhang LN, Zhu YZ, Wang MH, Ji XY, and Zhang L performed statistical analysis and interpreted the data; Ma LX, Zhang LN, Ji XY, and Zhang L conceived and designed the research study, supervised the study; Ji XY and Zhang L revised and edited the manuscript as co-corresponding authors; Zhang L acquired funding; all authors have reviewed and approved the final version of the manuscript.
AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Supported by Qingdao Key Medical and Health Discipline Project, No. 4910; The Intramural Research Program of the Affiliated Hospital of Qingdao University, No. 4901; The Shandong Province Innovation Development Joint Fund Key Support Project, No. ZR2024 LMB001; and The First Qilu Talent Engineering Health and Medical Personnel Project of Shandong Province, No. 5660.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (No. QYFYEC2024-218).
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The data used in the current study are available from the corresponding author upon reasonable request.
Corresponding author: Xiang-Yu Ji, MD, Department of Anesthesiology, Shandong Provincial Key Medical and Health Laboratory of Anesthesia and Brain Function, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Laoshan District, Qingdao 266100, Shandong Province, China.
jixiangyu@qdu.edu.cn
Received: April 13, 2026
Revised: May 21, 2026
Accepted: June 23, 2026
Published online: August 14, 2026
Processing time: 102 Days and 17.4 Hours
BACKGROUND
Compared to immediate cardiopulmonary complications during gastrointestinal endoscopy (GIE), post-procedural respiratory symptoms are often overlooked. Furthermore, an increased incidence of respiratory complications has been reported following GIE under moderate sedation (MS), administered by endoscopists or endoscopist-directed nurse sedation. However, monitored anesthesia care (MAC), which primarily involves deep sedation/general anesthesia (DS/GA), has not been evaluated yet regarding post-endoscopic respiratory complications.
AIM
To investigate the incidence of post-procedural respiratory complications and explore their links to different sedation strategies.
METHODS
In this single-center prospective cohort study, outpatients undergoing GIE under MAC were stratified into DS/GA (exposed) and MS (non-exposed) groups. Telephone follow-up post-procedure was used to assess symptoms such as cough, fever, and shortness of breath. Respiratory complications were defined as the presence of ≥ 2 respiratory symptoms, with further follow-up conducted to determine treatment and outcomes. Multivariate logistic regression was used to analyze the association between sedation depth and respiratory complications. Sensitivity analyses were conducted to verify reliability.
RESULTS
Seventy-seven of the 7230 patients experienced respiratory complications. Respiratory complications occurred 8.0 (4.0, 12.0) hours post-operatively, with a median duration of 1.5 (1.0, 2.5) days. Additional medical intervention was required in 23 cases. One patient (1/7230) was diagnosed with aspiration pneumonia and hospitalized for one week. All patients recovered without any severe sequelae. Compared with that in the MS group, the adjusted odds ratio for respiratory complications in the DS/GA group was 2.75 (95%CI: 1.32-5.71; P = 0.007). Subgroup analyses revealed similar patterns (all P values for interactions > 0.05). The association between DS/GA and respiratory complications remained significant in the sensitivity analysis after multiple imputation for 293 lost-to-follow-up patients (odds ratio = 2.86, 95%CI: 1.37-5.98).
CONCLUSION
Although DS/GA is associated with an increased risk of GIE-induced respiratory complications, MAC with sedation strategies tailored to patients’ risk factors may not significantly increase the incidence of respiratory complications.
Core Tip: This prospective cohort study investigated delayed respiratory complications after gastrointestinal endoscopy under monitored anesthesia care. Deep sedation or general anesthesia increased complication risk, while risk-stratified monitored anesthesia care strategies reduced adverse events in high-risk patients, providing key evidence for clinical sedation selection.
