title: Same-day bidirectional endoscopy with nonanesthesiologist administration of propofol: safety and cost-effectiveness compared with separated exams.
abstract: OBJECTIVE
  The safety and cost-effectiveness of a combination of esophagogastroduodenoscopy (EGD) and colonoscopy [or bidirectional endoscopy (BDE)] versus alternative-day EGD and colonoscopy when using nonanesthesiologist administration of propofol have never been evaluated.
  
  
  METHODS
  This was a single-center prospective registry of consecutive American Society of Anaesthesiology class I-III outpatients undergoing EGD, colonoscopy, and BDE. Propofol was the sole sedative used. Adverse events, recovery time, and procedure-related costs were analyzed.
  
  
  RESULTS
  Among the 1500 study participants (51.5% women), EGD, colonoscopy, and BDE were carried out on 449, 702, and 349 patients, respectively. All patients were discharged directly from the endoscopy unit. No sex differences were found with respect to age (mean 54.4, range 18-96 years), BMI, or procedure type. Propofol doses for BDE were 25.9% less than when EGD and colonoscopy were performed separately (P<0.001). Adverse events, including transient O2 saturation less than 90%, systolic blood pressure less than 90 mmHg, and bradycardia (<50 bpm), appeared in 10.7% of single EGD and 8.6% of EGD within BDE; for colonoscopies, the figures were 8.6 and 9.5%, respectively (P=NS). Recovery time to discharge after BDE was 47.9% shorter than when EGD and colonoscopy were performed separately (P<0.001). The cost of same-day BDE was 28.1% lower than that of EGD and colonoscopy performed as separated procedures (P<0.001).
  
  
  CONCLUSIONS
  Same-day BDE with nonanesthesiologist administration of propofol resulted in reductions in propofol doses, recovery time, and procedure-related costs as compared with carrying out EGD and colonoscopy separately, without an increase in adverse events.
authors.affiliation: aDepartment of Gastroenterology, Hospital General de Tomelloso bResearch Support Unit, Complejo Hospitalario La Mancha Centro, Ciudad Real, Spain.
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Lucendo
authors.forename: Ángel
authors.initials: Á
authors.lastname: Arias
authors.forename: Sonia
authors.initials: S
authors.lastname: González-Castillo
authors.forename: Teresa
authors.initials: T
authors.lastname: Angueira
authors.forename: Danila
authors.initials: D
authors.lastname: Guagnozzi
authors.forename: Mariluz
authors.initials: M
authors.lastname: Fernández-Fuente
authors.forename: Mercedes
authors.initials: M
authors.lastname: Serrano-Valverde
authors.forename: Marta
authors.initials: M
authors.lastname: Sánchez-Cazalilla
authors.forename: Oliver
authors.initials: O
authors.lastname: Chumillas
authors.forename: Maruja
authors.initials: M
authors.lastname: Fernández-Ordóñez
authors.forename: José M
authors.initials: JM
authors.lastname: Tenías
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000209:etiology; D003113:Colonoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D013030:Spain; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D010100:Oxygen; D015742:Propofol