title: Comparison of procedural sequences in same-day painless bidirectional endoscopy: Single-center, prospective, randomized study.
abstract: OBJECTIVE
  To compare the efficacy and safety of esophagogastroduodenoscopy (EGD)-colonoscopy and colonoscopy-EGD sequences for patients subjected to same-day bidirectional endoscopy under remifentanil and propofol sedation.
  
  
  METHODS
  A total of 209 eligible outpatients scheduled for diagnostic same-day bidirectional endoscopy between 16 February 2016 and 30 April 2016 were randomly assigned to the EGD-colonoscopy (n = 106) and colonoscopy-EGD (n = 103) sequence groups. Primary endpoint was total dose of propofol required for the procedure. Secondary endpoints included duration of endoscopy, patient satisfaction, adverse effects, endoscopy findings, and cardiopulmonary responses of the patients.
  
  
  RESULTS
  Patients in the two groups were similar in terms of demographic and clinical data (P > 0.05). EGD-colonoscopy sequence group had lesser requirement of propofol for sedation (P < 0.05), faster recovery (P < 0.001), and lesser influence on mean arterial pressure (MAP) during the endoscopy (P < 0.05). Duration of EGD and colonoscopy, patient satisfaction, adverse effects, and pathological findings did not differ between the two groups.
  
  
  CONCLUSIONS
  The EGD-colonoscopy sequence may be considered the preferred sequence for same-day bidirectional endoscopy as a result of less cardiovascular stress, lessened need for sedation with propofol, and faster recovery.
authors.affiliation: Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Jiao
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Ao
authors.affiliation: Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Kai-Yuan
authors.initials: KY
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Xiao-Chun
authors.initials: XC
authors.lastname: Shen
authors.affiliation: Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Dong-Feng
authors.initials: DF
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Chun-Hui
authors.identifier: http://orcid.org/0000-0001-5120-5135
authors.initials: CH
authors.lastname: Lan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003108:Colonic Diseases / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015742:Propofol / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: cardiopulmonary response; colonoscopy; esophagogastroduodenoscopy; same-day bidirectional endoscopy; sequence