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Abstract
Background & Aims
Complex endoscopic procedures are increasingly performed with anesthesia support,
which substantially impacts endoscopy unit efficiency. ERCP performed under general
anesthesia presents unique challenges, as patients are typically first intubated,
then transferred to the fluoroscopy table and positioned semi-prone. This requires
additional time and staff while increasing the potential for patient/staff injury.
We have developed the technique of Endoscopist-facilitated intubation using an endotracheal
tube backloaded onto an ultraslim gastroscope as a potential solution to these issues
and evaluated its utility prospectively.
Methods
Sequential patients undergoing ERCP were randomized to Endoscopist-facilitated intubation
or to Standard intubation. Demographic data, patient/procedure characteristics, endoscopy
efficiency parameters and adverse events were analyzed.
Results
During the study period, 45 ERCP patients were randomized to either Endoscopist-facilitated
intubation (n=23) or Standard intubation (n=22). Endoscopist-facilitated intubation
was successful in all patients, without hypoxic events. Median time from patient arrival
in room to procedural start was shorter in patients undergoing Endoscopist-facilitated
intubation vs Standard intubation (8.2 min vs. 29 min, p<0.0001). Endoscopist-facilitated
intubations were brisker than Standard intubations (0.63 min vs. 2.85 min, p<0.0001).
Endoscopist-facilitated intubation patients reported less post-procedure throat discomfort
(13% vs. 50%, p<0.01) and fewer myalgias (22% vs. 73%, p<0.01) than Standard intubation
patients.
Conclusions
Endoscopist-facilitated intubation was technically successful in every patient. Median
Endoscopist-facilitated intubation time from patient arrival in room to procedural
start was 3.5-fold lower and median Endoscopist-facilitated intubation time was over
4-fold lower than for Standard intubation. Endoscopist-facilitated intubation significantly
enhanced endoscopy unit efficiency and minimized staff and patient injury. General
adoption of this novel approach may represent a paradigm shift in the approach to
safe and efficient intubation of all patients requiring general anesthesia. While
the results of this controlled trial are promising, larger studies in a broad population
are needed to validate these findings. NCT 03879720.
Keywords
Acronyms & Abbreviations:
ERCP (Endoscopic Retrograde Cholangiopancreatography), EI (Endoscopist Facilitated Intubation), SI (Standard Intubation), Vs (versus), US (United States), CMS (Centers for Medicare and Medicaid Services), IQR (Interquartile ranges), SD (Standard Deviation), MAC (Monitored Anesthesia Care), GA (General Anesthesia)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
February 26,
2023
Received in revised form:
February 16,
2023
Received:
September 20,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures: None of the authors have any conflicts of interest pertaining to the study to
disclose.
This study was selected for oral presentation in the ASGE Presidential Plenary Session at DDW 2020.
Each of the three authors was involved in study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content and study supervision
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
