{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:45:53Z","timestamp":1791866753386,"version":"4.3.4"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2027,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To prospectively evaluate the feasibility of implementing a modified American Society of Anesthesiologists Physical Status (ASA\u2010PS)\u2010based sedation management system for endoscopist\u2010managed sedation in pancreatobiliary endoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center, single\u2010arm prospective feasibility study involved 2000 patients (2024\u20132025). Sedation risk was stratified using a modified ASA\u2010PS classification system combined with predefined high\u2010risk clinical factors (severe obesity, obstructive sleep apnea requiring continuous positive airway pressure, chronic obstructive pulmonary disease requiring home oxygen therapy, reduced functional capacity, and difficult sedation history). Patients meeting high\u2010risk criteria underwent pre\u2010procedural anesthesiologist assessment to determine sedation providers. The primary outcome was sedation\u2010related adverse event (SRAE) incidence during endoscopist\u2010managed sedation. The secondary outcomes were the sedation success rate and SRAE\u2010associated risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 2000 patients, 231 (11.6%) were classified as having high risk for sedation. Post\u2010assessment, anesthesiologists and endoscopists managed sedation for 86 (4.3%) and 1914 (95.7%) patients, respectively. In the endoscopist\u2010managed group, SRAEs occurred in 63 patients (3.3%), corresponding to a success rate of 96.7%. No patient required tracheal intubation or conversion to general anesthesia. In multivariable analysis, endoscopic ultrasonography\u2010guided sampling was independently associated with reduced SRAEs (odds ratio 0.407, 95% confidence interval 0.184\u20130.899;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.026); no independent predictors of increased SRAEs were identified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The modified ASA\u2010PS\u2010based sedation management system may be a feasible approach in settings with limited anesthesiology resources, warranting further validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>UMIN000053211<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/deo2.70445","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:58:39Z","timestamp":1791863919000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating a Modified American Society of Anesthesiologists Physical Status\u2010Based Sedation Management System for Pancreatobiliary Endoscopy: A Prospective Feasibility Study"],"prefix":"10.1002","volume":"7","author":[{"given":"Taro","family":"Hanaoka","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Kitasato University School of Medicine Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3671-1299","authenticated-orcid":false,"given":"Kosuke","family":"Okuwaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University School of Medicine Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1278-9021","authenticated-orcid":false,"given":"Masafumi","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University School of Medicine Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4878-680X","authenticated-orcid":false,"given":"Hiromi","family":"Matsuda","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Kitasato University School of Medicine Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4657-2736","authenticated-orcid":false,"given":"Kai","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University School of Medicine Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1251-9737","authenticated-orcid":false,"given":"Akihiro","family":"Tamaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University School of Medicine Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University School of Medicine Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayuko","family":"Sakai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Kitasato University School of Medicine Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chika","family":"Kusano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitasato University School of Medicine Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2007.12.046"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.12678"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13882"},{"key":"e_1_2_13_5_1","unstructured":"American Society of Anesthesiologists.ASA Physical Status Classification System: Committee of Oversight Economics(2020) https:\/\/dam.assets.ohio.gov\/image\/upload\/med.ohio.gov\/portals\/0\/resources\/asa%20physical%20status%20classification%20system.pdf."},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2017.07.018"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002043"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000000683"},{"issue":"4","key":"e_1_2_13_9_1","first-page":"244","article-title":"Validity and Reliability of the Observer's Assessment of Alertness\/Sedation Scale: Study With Intravenous Midazolam","volume":"10","author":"Chernik D. 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