Korean J Intern Med.
2020 Mar;35(2):331-341. 10.3904/kjim.2019.319.
Comparison of procedural sequence in same-day bidirectional endoscopy: a systematic review and meta-analysis
- Affiliations
-
- 1Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- 2Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- 3Department of Plastic Surgery, National Police Hospital, Seoul, Korea
- KMID: 2502019
- DOI: http://doi.org/10.3904/kjim.2019.319
Abstract
- Background/Aims
To compare the efficacy and safety of procedural sequence in same-day bidirectional endoscopy.
Methods
We searched OVID-MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar to identify randomized controlled trials that compared the procedural sequences in same-day bidirectional endoscopy, including esophagogastroduodenoscopy (EGD) and colonoscopy. The sedative and analgesic doses required, discomfort and satisfaction scores, procedure time, recovery time, adenoma detection rate, and failed cecal intubation were evaluated. Adverse effects, including respiratory and cardiovascular complications, were also assessed.
Results
We included six studies, with 1,848 patients in total. The requirement for sedative treatment was significantly lesser in the EGD-colonoscopy sequence than in the colonoscopy-EGD sequence (standardized mean difference [SMD], –0.39; 95% confidence interval [CI], –0.54 to –0.24; p = 0.12; I2 = 49%). Discomfort, scored by patients during the EGD procedure, was significantly lesser in the EGD-colonoscopy sequence than in the colonoscopy-EGD sequence (SMD, –0.45; 95% CI, –0.80 to –0.09; p = 0.02; I2 = 73%), while it was comparable during colonoscopy between the two sequences. Recovery time was significantly shorter in the EGD-colonoscopy sequence than in the colonoscopy-EGD sequence (SMD, –0.47; 95% CI, –0.65 to –0.30; p = 0.28; I2 = 21%). Total procedure duration, EGD, colonoscopy, cecal intubation time and incidence, incidences of pathologic findings, and adenoma detection were comparable between the two sequences. There was no significant difference in the incidences of desaturation, hypotension, hypertension, bradycardia, and tachycardia between the two sequences.
Conclusions
When conducting same-day bidirectional endoscopy, EGD followed by colonoscopy is the most beneficial sequence to be used because patients require lower sedative doses, recover faster, and report lesser discomfort.
