44 Conscious sedation in ERCP : the uncomfortable truth

BackgroundCompared with standard endoscopy, Endoscopic Retrograde Cholangio-Pancreatography(ERCP) is an uncomfortable, complex procedure that typically requires higher doses of sedative and analgesic medication. Our unit, like many throughout Ireland and the UK, performs the vast majority of ERCPs under conscious sedation. Challenges with appropriate sedation levels and patient compliance during ERCP are common.AimTo evaluate patient comfort (1-4) and sedation score (1–5) with conscious sedation using a scoring system based on the modified Gloucester score.MethodWe prospectively evaluated consecutive ERCPs performed under conscious sedation over a three-month period in a single, tertiary referral centre.Results121 patients were evaluated. The median age was 73, and 60/121 (49.6%) were female. 46 patients (38%) were ≥75 years. 62 patients (51%) had a comfort score of ≤2, and 59 (49%) had a comfort score of ≥3. One patient required reversal of sedation due to respiratory compromise. Median doses of medication were: midazolam (4.27 mg), diazepam (7.5 mg), fentanyl (84 mcg), and pethidine (35.7 mg). 7 patients received more than one benzodiazepines, 7 with more than one opiates and 6 with all four medications.ConclusionsThere are limited data to define what is acceptable sedation practice for ERCP. The RCPI have recently recommended that>80% of colonoscopies should have a comfort score of 1 or 2. Though there are no validated comfort scores for ERCP, our data demonstrate that many patients undergoing ERCP with conscious sedation are subjected to an experience that would be considered unacceptable in general endoscopy.