{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T21:42:18Z","timestamp":1740174138787,"version":"3.37.3"},"reference-count":33,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T00:00:00Z","timestamp":1695600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n            Background and study aims Because of concerns about peri-procedural adverse events (AEs), guidelines recommend anesthetist-managed sedation (AMS) for long and complex endoscopic procedures. The safety and efficacy of physician-administered balanced sedation (PA-BS) for endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs) \u226520 mm is unknown.<\/jats:p><jats:p>\n            Patients and methods We compared PA-BS with AMS in a retrospective study of prospectively collected data from consecutive patients referred for management of LNPCPs (NCT01368289; NCT02000141). A per-patient propensity analysis was performed following a 1:2 nearest-neighbor (Greedy-type) match, based on age, gender, Charlson comorbidity index, and lesion size. The primary outcome was any peri-procedural AE, which included hypotension, hypertension, tachycardia, bradycardia, hypoxia, and new arrhythmia. Secondary outcomes were unplanned admissions, 28-day re-presentation, technical success, and recurrence.<\/jats:p><jats:p>\n            Results Between January 2016 and June 2020, 700 patients\n      underwent EMR for LNPCPs, of whom 638 received PA-BS. Among them, the median age was 70 years\n      (interquartile range [IQR] 62\u201376 years), size 35 mm (IQR 25\u201345 mm), and duration 35 minutes\n      (IQR 25\u201360 minutes). Peri-procedural AEs occurred in 149 (23.4%), most commonly bradycardia\n      (116; 18.2%). Only five (0.8%) required an unplanned sedation-related admission due to AEs (2\n      hypotension, 1 arrhythmia, 1 bradycardia, 1 hypoxia), with a median inpatient stay of 1 day\n      (IQR 1\u20133 days). After propensity-score matching, there were no differences between PA-BS and\n      AMS in peri-procedural AEs, unplanned admissions, 28-day re-presentation rates, technical\n      success or recurrence.<\/jats:p><jats:p>\n            Conclusions Physician-administered balanced sedation for the EMR of LNPCPs is safe. Peri-procedural AEs are infrequent, transient, rarely require admission (&lt;1%), and are experienced in similar frequencies to those receiving anesthetist-managed sedation.<\/jats:p>","DOI":"10.1055\/a-2180-8880","type":"journal-article","created":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T23:08:20Z","timestamp":1695683300000},"page":"E1-E10","source":"Crossref","is-referenced-by-count":1,"title":["Safety and efficacy of physician-administered balanced-sedation for the endoscopic mucosal resection of large non-pedunculated colorectal polyps"],"prefix":"10.1055","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct01368289","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02000141","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3471-8304","authenticated-orcid":false,"given":"Sunil","family":"Gupta","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"},{"name":"Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8207-115X","authenticated-orcid":false,"given":"Rajiv","family":"Kurup","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal","family":"Shahidi","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"},{"name":"Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia"},{"name":"Gastroenterology and Hepatology, The University of British Columbia Faculty of Medicine, Vancouver, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5600-2668","authenticated-orcid":false,"given":"Sergei","family":"Vosko","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8280-216X","authenticated-orcid":false,"given":"Owen","family":"McKay","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simmi","family":"Zahid","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Whitfield","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"},{"name":"Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric Y.","family":"Lee","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"},{"name":"Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen John","family":"Williams","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4434-1627","authenticated-orcid":false,"given":"Nicholas Graeme","family":"Burgess","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"},{"name":"Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Bourke","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia"},{"name":"Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,1,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1016\/j.gie.2009.07.020","article-title":"Position statement: nonanesthesiologist administration of propofol for GI endoscopy","volume":"70","author":"JJ Vargo","year":"2009","journal-title":"Gastrointest Endosc"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1111\/den.12219","article-title":"Propofol versus traditional sedative agents for advanced endoscopic procedures: A meta-analysis","volume":"26","author":"S Sethi","year":"2014","journal-title":"Dig Endosc"},{"key":"ref3","first-page":"303","article-title":"Safety and efficacy of endoscopist-directed balanced propofol sedation during endoscopic retrograde cholangiopancreatography","volume":"32","author":"A Lapidus","year":"2019","journal-title":"Ann Gastroenterol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1136\/gutjnl-2017-313823","article-title":"Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis","volume":"67","author":"FF Bahin","year":"2018","journal-title":"Gut"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1016\/j.gie.2014.04.015","article-title":"Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon","volume":"80","author":"G Ahlenstiel","year":"2014","journal-title":"Gastrointest Endosc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/j.cgh.2015.08.037","article-title":"Cost analysis of endoscopic mucosal resection vs surgery for large laterally spreading colorectal lesions","volume":"14","author":"M Jayanna","year":"2016","journal-title":"J Clin Gastroenterol Hepatol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1053\/j.gastro.2019.12.018","article-title":"Endoscopic removal of colorectal lesions\u2014recommendations by the US Multi-Society Task Force on Colorectal Cancer","volume":"158","author":"T Kaltenbach","year":"2020","journal-title":"Gastroenterology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1055\/s-0043-102569","article-title":"Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline","volume":"49","author":"M Ferlitsch","year":"2017","journal-title":"Endoscopy"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.gie.2019.08.004","article-title":"Trends in EMR for nonmalignant colorectal polyps in the United States","volume":"91","author":"XY Jessica","year":"2020","journal-title":"Gastrointest Endosc"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"958","DOI":"10.14309\/ajg.0000000000001096","article-title":"Previously attempted large nonpedunculated colorectal polyps are effectively managed by endoscopic mucosal resection","volume":"116","author":"N Shahidi","year":"2021","journal-title":"Am J Gastroenterol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1136\/gutjnl-2019-319785","article-title":"Endoscopic mucosal resection is effective for laterally spreading lesions at the anorectal junction","volume":"69","author":"N Shahidi","year":"2020","journal-title":"Gut"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.gie.2021.05.011","article-title":"Impact of technical innovations in endoscopic mucosal resection in the treatment\n          of large nonpedunculated polyps involving the ileocecal valve (with video)","volume":"95","author":"S Vosko","year":"2021","journal-title":"Gastrointest Endosc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1136\/gutjnl-2015-309848","article-title":"Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors","volume":"66","author":"NG Burgess","year":"2017","journal-title":"Gut"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/j.gie.2013.01.021","article-title":"Topical submucosal chromoendoscopy defines the level of resection in colonic EMR and may improve procedural safety (with video)","volume":"77","author":"BA Holt","year":"2013","journal-title":"Gastrointest Endosc"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1053\/j.gastro.2018.10.003","article-title":"Thermal ablation of mucosal defect margins reduces adenoma recurrence after colonic endoscopic mucosal resection","volume":"156","author":"A Klein","year":"2019","journal-title":"Gastroenterology"},{"key":"ref16","first-page":"52","article-title":"Cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST) is an effective and safe strategy for the management of non-lifting large laterally spreading colonic lesions","volume":"41","author":"DJ Tate","year":"2018","journal-title":"Endoscopy"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"147","author":"E von Elm","year":"2007","journal-title":"Ann Intern Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1053\/j.gastro.2016.12.029","article-title":"How to perform high-quality endoscopic mucosal resection during colonoscopy","volume":"152","author":"A Klein","year":"2017","journal-title":"Gastroenterology"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1053\/j.gastro.2011.02.062","article-title":"Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia","volume":"140","author":"A Moss","year":"2011","journal-title":"Gastroenterology"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/j.giec.2019.05.002","article-title":"How to perform wide-field endoscopic mucosal resection and follow-up examinations","volume":"29","author":"B Jideh","year":"2019","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.giec.2014.11.005","article-title":"Advanced polypectomy and resection techniques","volume":"25","author":"A Klein","year":"2015","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.gie.2019.08.031","article-title":"How I remove polyps larger than 20 mm","volume":"90","author":"MJ Bourke","year":"2019","journal-title":"Gastrointest Endosc"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1055\/a-1832-4232","article-title":"Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative","volume":"54","author":"H-L Ching","year":"2022","journal-title":"Endoscopy"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/S2468-1253(21)00384-8","article-title":"Effect of prophylactic endoscopic clip placement on clinically significant post-endoscopic mucosal resection bleeding in the right colon: a single-centre, randomised controlled trial","volume":"7","author":"S Gupta","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1016\/j.gie.2009.10.027","article-title":"A lexicon for endoscopic adverse events: report of an ASGE workshop","volume":"71","author":"PB Cotton","year":"2010","journal-title":"Gastrointest Endosc"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1016\/j.gie.2010.04.040","article-title":"Projected increased growth rate of anesthesia professional\u2013delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015","volume":"72","author":"JM Inadomi","year":"2010","journal-title":"Gastrointest Endosc"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4103\/0976-5042.173961","article-title":"Endoscopist-directed balanced propofol sedation is safe and effective in patients undergoing outpatient colonoscopy","volume":"6","author":"J Nathan","year":"2015","journal-title":"Dig Endosc"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1055\/s-0034-1393414","article-title":"Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy nurses and associates guideline\u2013updated June 2015","volume":"47","author":"J-M Dumonceau","year":"2015","journal-title":"Endoscopy"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1016\/j.gie.2008.09.029","article-title":"Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy Guidelines","volume":"68","author":"D Lichtenstein","year":"2008","journal-title":"Gastrointest Endosc"},{"key":"ref31","first-page":"265","article-title":"Variability in the American Society of Anesthesiologists physical status classification scale","volume":"71","author":"WL Aronson","year":"2003","journal-title":"AANA J"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1093\/bja\/aeu100","article-title":"Reliability of the American Society of Anesthesiologists physical status scale in clinical practice","volume":"113","author":"A Sankar","year":"2014","journal-title":"Br J Anaesth"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1097\/00000542-197008000-00006","article-title":"The risk of anesthesia","volume":"33","author":"A Goldstein","year":"1970","journal-title":"Anesthesiology"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.gie.2010.09.035","article-title":"Balanced propofol sedation for therapeutic GI endoscopic procedures: a prospective, randomized study","volume":"73","author":"CK Lee","year":"2011","journal-title":"Gastrointest Endosc"}],"container-title":["Endoscopy International Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2180-8880.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T10:35:15Z","timestamp":1730802915000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2180-8880"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,25]]},"references-count":33,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2024,1,5]]},"published-print":{"date-parts":[[2024,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2180-8880","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2364-3722","2196-9736"],"issn-type":[{"type":"print","value":"2364-3722"},{"type":"electronic","value":"2196-9736"}],"subject":[],"published-other":{"date-parts":[[2023,9,25]]},"published":{"date-parts":[[2023,9,25]]}}}