title: Paired comparison of procedural sequence in same-day bidirectional endoscopy with moderate sedation and carbon dioxide insufflation: A prospective observational study.
abstract: OBJECTIVE
  Same-day bidirectional endoscopy (BDE) is a commonly performed procedure, but the optimal sequence of the procedure with carbon dioxide insufflation is not well established. In this study, we investigated the optimal sequence for same-day BDE without polypectomy under moderate sedation and carbon dioxide insufflation in terms of sedation doses and colonoscopy performance.
  
  
  METHODS
  We performed a prospective observational study of 63 asymptomatic patients who were admitted for physical check-ups. A colonoscopy-esophagogastroduodenoscopy (EGD) examination was performed first and then an EGD-colonoscopy examination was performed within 1.5 years.
  
  
  RESULTS
  The total procedure time, procedure complexity, bowel preparation quality, cecal intubation time, colon polyp detection rate, and adverse events were similar between the two study groups. The total doses of fentanyl and midazolam were significantly higher for the colonoscopy-EGD group than that for the EGD-colonoscopy group (70.8 ± 9.6 μg vs. 56.6 ± 9.2 μg and 6.1 ± 1.3 mg vs. 4.6 ± 1.1 mg, P < 0.0001 and P < 0.0001, respectively). The recovery time to discharge was significantly longer for the colonoscopy-EGD group compared to the EGD-colonoscopy group (38.5 ± 3.9 min vs. 31.9 ± 3.2 min, P < 0.001, respectively).
  
  
  CONCLUSIONS
  EGD-colonoscopy is the optimal sequence for same-day BDE. In this order, the procedures are better tolerated, the sedation doses are reduced, and the recovery time is shorter.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jui-Hsiang
authors.initials: JH
authors.lastname: Tang
authors.affiliation: Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, Taoyuan City, Taiwan.
authors.forename: Chi-Liang
authors.initials: CL
authors.lastname: Cheng
authors.affiliation: Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, Taoyuan City, Taiwan.
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Kuo
authors.affiliation: Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, Taoyuan City, Taiwan.
authors.forename: Yi-Ning
authors.initials: YN
authors.lastname: Tsui
mesh_terms: D002245:Carbon Dioxide / Q000627:therapeutic use*; D003113:Colonoscopy / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D007327:Insufflation; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D002245:Carbon Dioxide