Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation

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Kilian Friedrich1, Sabine G. Scholl2, Sebastian Beck1, Daniel Gotthardt1, Wolfgang Stremmel1, Douglas K. Rex3, bng-Study-Group, Andreas Sieg1,4

1) University Hospital of Heidelberg, Department IV, Heidelberg
2) Department of Social Psychology, University of Mannheim, Mannheim, Germany
3) Indiana University Hospital, Department of Gastroenterology, 550 University Boulevard,
Indianapolis, IN, USA
4) Practice of Gastroenterology Bergheimer Str. 56a, 69115 Heidelberg, Germany



Background & Aims:
Respiratory complications represent an important adverse event of endoscopic
procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire
and followed-up patients suggestive of respiratory infection.

Method: In this prospective observational, multicenter study performed in Outpatient practices of
gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.

Results: 832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).

Conclusions: We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.

Key words: endoscopist-directed propofol sedation - respiratory complications - pulmonary infection -
outpatient endoscopy .