Short-Acting Sedative Agents During Endoscopic Retrograde Cholangiopancreatography: A Review of Clinical Effectiveness and Guidelines [Internet]

Endoscopic retrograde cholangiopancreatography (ERCP) is essential in the diagnosis and treatment of pancreaticobiliary pathologies. The procedure time ranges from 30 to 60 minutes, and it is commonly performed in endoscopy suites away from the operating room. ERCP is a minimally invasive technique and has fewer complications, generally shorter hospitalization times, and lower medical costs compared to traditional surgery, particularly in sick and elderly patients suffering from hepatobiliary tract disorders. The procedure may be performed under general anesthesia to keep patients stable or with moderate to deep levels of sedation and analgesia to minimize patient discomfort during the procedure. However, potential complications involving respiratory and cardiovascular conditions, which may be related to the level of sedation, may occur during the operation. Essential factors to consider concerning the level of sedation for ERCP procedure include patient tolerance, the presence of comorbidities, the endoscopist’s comfort and ease of the procedure, staff, equipment, and anesthesia support available in the endoscopy suite. Benzodiazepine, opiates, and propofol in different combinations are commonly administered to provide conscious or deep sedation for patients undergoing ERCP. It has been reported that one-third to one-half of patients undergoing ERCP under conscious sedation experience discomfort and pain. Thus, there is a need for a sedation method or regimen that offers efficacy and has an excellent safety profile regarding sedation-related side effects.

This report aims to identify and summarize evidence on the clinical effectiveness of short-acting sedative agents for conscious sedation during ERCP. An additional objective is to synthesize evidence-based guidelines for moderate procedural sedation during ERCP.