Sedative techniques for endoscopic retrograde cholangiopancreatography (ERCP)

Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) procedures under propofol sedation may become sedated faster, tolerate the procedure better and recover faster than those receiving sedation with midazolam and meperidine. There seems to be no difference between the groups regarding mortality, hypoxaemia, hypotension or rate of completion of procedure.

The quality of evidence is downgraded by study limitations (lack of allocation concealment and lack of blinding).

Summary

A Cochrane review included 4 studies with a total of 510 patients to evaluate the efficacy and safety of sedative or anaesthetic techniques used during ERCP in adult patients. Deep sedation (using propofol) was compared to conscious sedation (using midazolam plus opioid).

Primary outcomes were defined as mortality, hypoxaemia, hypotension and failure to complete the procedure. There was no difference between the two sedation groups in the incidence of hypoxaemia during the procedure in any of the trials. No deaths were reported during sedation or immediately after the procedure in either group. There was no significant difference in the incidence of serious hypotension between the two sedation groups in any of the trials. One trial reported that three patients in the propofol group and two in the midazolam group had to have the procedure terminated due to sedation-related problems.

In the propofol-group the onset of effective sedation was shorter (in 2 of 3 studies), patient co-operation was superior (in 2 of 3 studies) and recovery from sedation was significantly better (all secondary outcomes). No conclusions can be made regarding the safety of each technique.

Clinical comments

Propofol should only be used by trained anaesthesia personnel.

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Ədəbiyyat

1. Garewal D, Powell S, Milan SJ et al. Sedative techniques for endoscopic retrograde cholangiopancreatography. Cochrane Database Syst Rev 2012;6:CD007274.