Risk of respiratory complications following gastrointestinal endoscopy under monitored anesthesia care: A prospective cohort study

doi:10.3748/wjg.122191

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Aug 14, 2026; 32(30): 122191
Published online Aug 14, 2026. doi: 10.3748/wjg.122191

Table 1 Baseline characteristics of the study population, mean ± SD/n (%)

Variables	Total (n = 7230)	MAC		P value
Variables	Total (n = 7230)	MS (n = 1531)	DS/GA (n = 5699)	P value
Age (years)	52.1 ± 12.7	53.1 ± 13.1	51.9 ± 12.6	< 0.001
Sex				0.002
Male	3579 (49.5)	812 (53.0)	2767 (48.6)
Female	3651 (50.5)	719 (47.0)	2932 (51.4)
BMI (kg/m²)	24.7 ± 3.4	25.4 ± 4.4	24.5 ± 3.1	< 0.001
ASA classification				< 0.001
I	3012 (41.7)	452 (29.5)	2560 (44.9)
II	3605 (49.9)	802 (52.4)	2803 (49.2)
≥ III	613 (8.5)	277 (18.1)	336 (5.9)
Smoker	271 (3.7)	76 (5.0)	195 (3.4)	0.005
Alcohol drinker	311 (4.3)	70 (4.6)	241 (4.2)	0.557
Underlying pulmonary disease
Asthma	82 (1.1)	43 (2.8)	39 (0.7)	< 0.001
COPD	93 (1.3)	33 (2.2)	60 (1.1)	< 0.001
Cardiovascular disease
Hypertension	1604 (22.2)	382 (25.0)	1222 (21.4)	0.003
Heart disease	602 (8.3)	258 (16.9)	344 (6.0)	< 0.001
Neurological diseases
Cerebrovascular	104 (1.4)	60 (3.9)	44 (0.8)	< 0.001
Depression	39 (0.5)	0 (0.0)	39 (0.7)	0.001
Diabetes mellitus	683 (9.4)	164 (10.7)	519 (9.1)	0.057
Gastrointestinal disorders
GERD	541 (7.5)	355 (23.2)	186 (3.3)	< 0.001
Hiatus hernia	84 (1.2)	46 (3.0)	38 (0.7)	< 0.001
Gastrointestinal ulcer	343 (4.7)	107 (7.0)	236 (4.1)	< 0.001
Surgical history
Upper gastrointestinal surgery	176 (2.4)	130 (8.5)	46 (0.8)	< 0.001
Colorectal surgery	324 (4.5)	80 (5.2)	244 (4.3)	0.113
Pulmonary surgery	153 (2.1)	37 (2.4)	116 (2.0)	0.357
Oral-pharyngeal surgery	40 (0.6)	32 (2.1)	8 (0.1)	< 0.001
Intraoperative respiratory adverse events
Severe cough	51 (0.7)	9 (0.6)	42 (0.7)	0.536
Regurgitation and aspiration	12 (0.2)	0 (0.0)	12 (0.2)	0.083
Hypoxemia	215 (3.0)	39 (2.5)	176 (3.1)	0.269
Procedure type				0.063
Combined	5465 (75.6)	1123 (73.4)	4342 (76.2)
EGD	1059 (14.6)	249 (16.3)	810 (14.2)
Colonoscopy	706 (9.8)	159 (10.4)	547 (9.6)
Procedure time				0.102
< 10 minutes	1425 (19.7)	326 (21.3)	1099 (19.3)
10-30 minutes	5159 (71.4)	1059 (69.2)	4100 (71.9)
> 30 minutes	646 (8.9)	146 (9.5)	500 (8.8)
Respiratory complications	77 (1.1)	13 (0.8)	64 (1.1)	0.354

ASA: American Society of Anesthesiologists; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; EGD: Esophagogastroduodenoscopy; GERD: Gastroesophageal reflux disease; MAC: Monitored anesthesia care; MS: Moderate sedation; DS: Deep sedation; GA: General anesthesia.

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Table 2 Characteristics of gastrointestinal endoscopy-associated respiratory complications, median (interquartile range)/n (%)

Item	Respiratory complications
Item	Total (n = 77)	Cough + SOB (n = 55)	Cough + fever (n = 16)	Fever + SOB (n = 3)	Cough + fever + SOB (n = 3)
Post-procedure (hours)	8.0 (4.0, 12.0)	10.0 (4.0, 12.8)	5.8 (4.2, 9.8)	6.8 (5.2, 10.9)	4.5 (4.2, 5.0)
Duration (days)	1.5 (1.0, 2.5)	1.3 (0.8, 2.5)	1.5 (1.0, 2.0)	1.0 (0.9, 1.0)	4.0 (3.0, 6.5)
Aspiration pneumonia	1 (1.2)	0 (0.0)	0 (0.0)	0 (0.0)	1 (16.7)
Further medical treatment¹	Yes: 23 (29.9)	Yes: 9 (16.4)	Yes: 10 (62.5)	Yes: 1 (33.3)	Yes: 3 (100)
Further medical treatment¹	No: 54 (70.1)	No: 46 (83.6)	No: 6 (37.5)	No: 2 (66.7)	No: 0 (0.0)

¹Pharmacotherapy, hospitalization, or further diagnosis.

SOB: Shortness of breath.

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Table 3 Associations between different sedation levels and respiratory complications during gastrointestinal endoscopy according to a multiple regression model

Item	Respiratory complications, number/total number		OR (95%CI)	P value
Item	MS	DS/GA	OR (95%CI)	P value
Crude model	13/1531	64/5699	1.33 (0.73-2.41)	0.356
Model 1¹	13/1531	64/5699	1.57 (0.84-2.91)	0.155
Model 2²	13/1531	64/5699	2.29 (1.16-4.54)	0.017
Model 3³	13/1531	64/5699	2.75 (1.32-5.71)	0.007

¹Adjusted for American Society of Anesthesiologists classification.

²Additionally, adjusted for heart disease, asthma, hiatus hernia, gastrointestinal ulcer, and gastroesophageal reflux disease.

³Further adjusted for a history of upper gastrointestinal and oral-pharyngeal surgery, as well as regurgitation and aspiration.

OR: Odds ratio; GA: General anesthesia; MS: Moderate sedation; DS: Deep sedation.

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Table 4 Sensitivity analysis

Item	Respiratory complications, number/total number		OR (95%CI)	P value
Item	MS	DS/GA	OR (95%CI)	P value
Multiple imputation for loss to follow-up data
Crude model	13/1585	67/5938	1.32 (0.72-2.40)	0.367
Model 1¹	13/1585	67/5938	1.54 (0.83-2.86)	0.168
Model 2²	13/1585	67/5938	2.25 (1.14-4.46)	0.020
Model 3³	13/1585	67/5938	2.86 (1.37-5.98)	0.005
Sensitivity analysis based on MW
Crude	13/1531	64/5699	1.33 (0.73-2.41)	0.356
After MW	-	-	3.02 (1.49-6.13)	0.002

¹Adjusted for American Society of Anesthesiologists classification.

²Additionally, adjusted for heart disease, asthma, hiatus hernia, gastrointestinal ulcer, and gastroesophageal reflux disease.

³Further adjusted for a history of upper gastrointestinal and oral-pharyngeal surgery, as well as regurgitation and aspiration.

-: It indicates that no weighted patient counts are presented, as they do not represent actual clinical numbers; OR: Odds ratio; GA: General anesthesia; MS: Moderate sedation; DS: Deep sedation; MW: Matching weighting.

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Citation: Ma LX, Zhang LN, Zhu YZ, Wang MH, Du XB, Qi LJ, Sun J, Yi XL, Wang P, Zhou ZG, Ji XY, Zhang L. Risk of respiratory complications following gastrointestinal endoscopy under monitored anesthesia care: A prospective cohort study. World J Gastroenterol 2026; 32(30): 122191
URL: https://www.wjgnet.com/1007-9327/full/v32/i30/122191.htm
DOI: https://dx.doi.org/10.3748/wjg.122191

Ma LX, Zhang LN, Zhu YZ, Wang MH, Du XB, Qi LJ, Sun J, Yi XL, Wang P, Zhou ZG, Ji XY, Zhang L. Risk of respiratory complications following gastrointestinal endoscopy under monitored anesthesia care: A prospective cohort study. World J Gastroenterol 2026; 32(30): 122191 [DOI: 10.3748/wjg.122191]

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