Choice of sedation in endoscopic retrograde cholangiopancreatography: is monitored anesthesia care as safe as general anesthesia? A systematic review and meta-analysis

Amaninder Dhaliwal; Banreet Singh Dhindsa; Syed Mohsin Saghir; Daryl Ramai; Saurabh Chandan; Harmeet Mashiana; Neil Bhogal; Harlan Sayles; Ishfaq Bhat; Shailender Singh; Aamir Dam; Pushpak Taunk; Rene Gomez Esquivel; Jason Klapman; Stephanie McDonough; Douglas G Adler

doi:10.20524/aog.2021.0650

Choice of sedation in endoscopic retrograde cholangiopancreatography: is monitored anesthesia care as safe as general anesthesia? A systematic review and meta-analysis

Ann Gastroenterol. 2021 Nov-Dec;34(6):879-887. doi: 10.20524/aog.2021.0650. Epub 2021 Jul 2.

Authors

Amaninder Dhaliwal¹, Banreet Singh Dhindsa², Syed Mohsin Saghir³, Daryl Ramai⁴, Saurabh Chandan⁵, Harmeet Mashiana⁶, Neil Bhogal⁷, Harlan Sayles⁸, Ishfaq Bhat⁶, Shailender Singh⁶, Aamir Dam¹, Pushpak Taunk⁹, Rene Gomez Esquivel⁹, Jason Klapman¹, Stephanie McDonough¹⁰, Douglas G Adler¹⁰

Affiliations

¹ Division of Gastroenterology and Hepatology, Moffitt Cancer Center, Tampa, FL (Amaninder Dhaliwal, Aamir Dam, Jason Klapman).
² Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE (Banreet Singh Dhindsa).
³ Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas (Syed Mohsin Saghir).
⁴ Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York (Daryl Ramai).
⁵ Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE (Saurabh Chandan).
⁶ Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE (Harmeet Mashiana, Ishfaq Bhat, Shailender Singh).
⁷ Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE (Neil Bhogal).
⁸ Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE (Harlan Sayles).
⁹ Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL (Pushpak Taunk, Rene Gomez Esquivel).
¹⁰ Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT (Stephanie McDonough, Douglas G. Adler), USA.

Abstract

Background: Monitored anesthesia care (MAC) and general anesthesia (GA) are the 2 most common methods of sedation used for endoscopic retrograde cholangiopancreatography (ERCP). We performed a systematic review and meta-analysis to compare the overall safety between MAC vs. GA in ERCP.

Methods: We conducted a comprehensive search of electronic databases to identify studies reporting the use of MAC or GA as a choice of sedation for ERCP. The primary outcome was to compare the overall rate of sedation-related adverse events in MAC vs. GA groups. The secondary endpoint was to investigate the total duration of the procedure, recovery time, ERCP cannulation rates, and conversion rate of MAC to GA. The meta-analysis was performed using a Der Simonian and Laird random-effects model.

Results: A total of 21 studies reporting on 11,592 patients were included. The overall sedation-related side-effects were similar in the GA (12.76%, 95% confidence interval [CI] 5.80-21.73; I²=95%) and MAC (12.08%, 95%CI 5.38-20.89; I²=99%) groups (P=0.956). Hypoxia, arrhythmias, hypotension, aspiration and other sedation-related side-effects were similar between the 2 groups. The mean duration of the procedure was longer in the MAC group, but the mean recovery time was shorter. Significant heterogeneity was noted in our meta-analysis.

Conclusions: In our meta-analysis, the overall sedation-related side-effects were similar between the MAC and GA groups. MAC could be used as a safer alternative to GA when performing ERCP. However, large multicenter randomized control trials are needed to further validate our findings.

Keywords: ERCP; Sedation; adverse events; anesthesia; meta-analysis.