title: Prospective evaluation of gastroenterologist-guided, nurse-administered standard sedation for spiral deep small bowel enteroscopy.
abstract: BACKGROUND
  Sedation of patients for deep small bowel enteroscopy presents unique challenges and is traditionally provided by anesthesiologists. No study has directly evaluated gastroenterologist-guided, nurse-administered sedation for deep enteroscopy. Further, no comparison exists between gastroenterologist-guided versus anesthesiologist-guided sedation during deep enteroscopy.
  
  
  OBJECTIVE
  To evaluate safety and efficacy of performing deep (spiral) enteroscopy using gastroenterologist-guided sedation and compare outcomes between patients receiving gastroenterologist-guided and anesthesiologist-guided sedation.
  
  
  METHODS
  This prospective case series contains 91 consecutive patients who underwent deep enteroscopy with spiral Endo-Ease Discovery SB overtube. Of the patients, 64 received gastroenterologist-guided and 27 received anesthesiologist-guided sedation.
  
  
  RESULTS
  In the 64 patients receiving gastroenterologist-guided sedation, successful completion occurred in 59 of 64 enteroscopies (92.2%). Mean insertion depth was 231.0+/-85.8 cm beyond the ligament of Treitz. Total procedure time was 39.9+/-15.7 min (diagnostic time 34.7+/-12.3 min; therapy time 5.2+/-8.9 min). Positive findings were noted in 32 cases (50.0%), with therapy performed in 27 cases (42.2%). Six minor complications occurred. Compared to the anesthesiologist-guided sedation group, there was no difference in patient characteristics except mean American Society of Anesthesiologists score (2.5+/-0.5 in gastroenterologist-guided group versus 2.7+/-0.6 in anesthesiologist-guided group; p=0.046) and presence of adhesions (ten in gastroenterologist-guided group and zero in anesthesiologist-guided group; p=0.030). Outcomes for both groups were not significantly different except for shorter times in the gastroenterologist-guided group (39.9+/-15.7 min versus 46.0+/-12.1 min; p=0.047) and more frequent findings in the anesthesiologist-guided group (50.0% vs. 74.1%; p=0.034).
  
  
  CONCLUSIONS
  Deep enteroscopy using the spiral overtube can be successfully and safely accomplished with gastroenterologist-guided, nurse-administered standard sedation.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, 1600 SW Archer Rd, Room HD 602, PO Box 100214, Gainesville, FL, 32610, USA, judahja@medicine.ufl.edu.
authors.forename: J R
authors.initials: JR
authors.lastname: Judah
authors.forename: D
authors.initials: D
authors.lastname: Collins
authors.forename: J K
authors.initials: JK
authors.lastname: Gaidos
authors.forename: W
authors.initials: W
authors.lastname: Hou
authors.forename: C E
authors.initials: CE
authors.lastname: Forsmark
authors.forename: P V
authors.initials: PV
authors.lastname: Draganov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation / Q000009:adverse effects / Q000451:nursing*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005260:Female; D005431:Florida; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009719:Nurse Anesthetists; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult