Cha MH, Sandooja R, Khalid S, Lao N, Lim J, Razik R. Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: A large single-center retrospective review. World J Gastrointest Endosc 2021; 13(2): 45-55 [PMID: 33623639 DOI: 10.4253/wjge.v13.i2.45]
Corresponding Author of This Article
Roshan Razik, FRCPC, MD, MPH, Attending Physician, Department of Gastroenterology, Cleveland Clinic Akron General, 1 Akron General Ave Akron, Akron, OH 44307, United States. razikr@ccf.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ming-Han Cha, Rashi Sandooja, Saher Khalid, Nicole Lao, Joseph Lim, Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH 44307, United States
Roshan Razik, Department of Gastroenterology, Cleveland Clinic Akron General, Akron, OH 44307, United States
Author contributions: Razik R and Cha MH conceived and planned the retrospective chart review; Cha MH, Sandooja R, Khalid S, Lim J and Lao N carried out the chart review process; Cha MH and Razik R contributed to the interpretation of the results from the chart review; Cha MH took lead in the writing of manuscript, with all other authors provided critical feedback that helped finalized the manuscript; Razik R supervised the entire project.
Institutional review board statement: The study was reviewed and approved by the Cleveland Clinic Akron General Institutional Review Board (Approval No. 19007).
Informed consent statement: A waiver of informed consent is granted by the Institutional Review Board at Cleveland Clinic Akron General as this study may not be practicably conducted due to the number of patients lost to follow up and/or expired since the procedure. Please refer to IRB approval letter for further details.
Conflict-of-interest statement: There are no conflict of interest pertaining to this manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at razikr@ccf.org. Consent was not obtained but the presented data are anonymized and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Roshan Razik, FRCPC, MD, MPH, Attending Physician, Department of Gastroenterology, Cleveland Clinic Akron General, 1 Akron General Ave Akron, Akron, OH 44307, United States. razikr@ccf.org
Received: December 4, 2020 Peer-review started: December 4, 2020 First decision: December 18, 2020 Revised: December 31, 2020 Accepted: January 21, 2021 Article in press: January 21, 2021 Published online: February 16, 2021 Processing time: 60 Days and 14.2 Hours
ARTICLE HIGHLIGHTS
Research background
Foreign object ingestion (FOI) and food bolus impaction (FBI) are common causes of emergent endoscopic intervention. However, the choice of sedation used during emergent endoscopy for foreign bodies is often dictated by physician experience.
Research motivation
Currently, there is insufficient data examining the safety of different sedation modalities in emergent endoscopy for removal of ingested foreign objects or FBI.
Research objectives
To investigate the complication rates of emergent endoscopic extraction performed under different sedation modalities, namely conscious sedation (CS), monitored anesthesia care (MAC) and general anesthesia (GA).
Research methods
A standardized questionnaire was utilized to collect data on demographics, endoscopic details, sedation practices, hospital stay and adverse events of endoscopic procedures for foreign body removal. Subsequently, complication rates of patients who underwent emergent endoscopic retrieval were compared based on sedation modalities.
Research results
Among the 929 procedures analyzed, 353 procedures (38.0%) were performed under CS, 278 procedures (29.9%) under MAC and the rest (32.1%) under GA. Analysis revealed no statistically significant difference in the complication rate between patients sedated under CS (14.7%), MAC (14.7%) and GA (19.5%), P = 0.19. However, patients that underwent MAC and GA were found to be more likely to require hospitalization. This may be due to longer inpatient psychiatric monitoring as many patients who underwent MAC and GA presented with FOI due to underlying psychiatric disorder.
Research conclusions
Emergent endoscopy for foreign body removal under CS is not associated with significantly higher complication rates compared to MAC and GA.
Research perspectives
Future prospective studies are needed to identify various clinical factors that contributes to higher risk for endoscopy-related adverse events.
