{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:40:00Z","timestamp":1786448400914,"version":"build-2736575974"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":36,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Liver transplant recipients frequently undergo endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications and may be at increased risk of sedation-related adverse events. However, data regarding sedation-related outcomes in this population remain limited. This study aimed to evaluate the incidence, characteristics, and potential predictors of sedation-related complications during ERCP in liver transplant recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study including adult liver transplant recipients who underwent ERCP under anesthesiologist-administered deep sedation between July 2021 and June 2022. For patients who underwent multiple ERCP procedures, only the first procedure was included. Sedation-related complications were defined as the occurrence of one or more of the following events during ERCP or within 60\u00a0min after the procedure: oxygen desaturation, hypotension, bradycardia, apnea, or airway intervention. Univariable and multivariable logistic regression analyses were performed to identify factors associated with complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 76 patients were included. Sedation-related complications occurred in 21 procedures (27.6%). Oxygen desaturation was the most common event (22.4%), followed by hypotension (9.2%), apnea (3.9%), and bradycardia (2.6%). Airway intervention, consisting exclusively of jaw thrust maneuvers, was required in 10 procedures (13.2%). No patient required bag-mask ventilation, supraglottic airway placement, endotracheal intubation, or procedure termination due to sedation-related instability. In univariable analyses, longer procedure duration and higher propofol dose were associated with complications. No independent predictors were identified after multivariable adjustment. However, given the limited sample size and number of events, the study may have been underpowered to detect modest associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sedation-related cardiopulmonary events were common but predominantly mild and transient. No independent predictors were identified after multivariable adjustment; however, the study may have been underpowered to detect modest associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-026-05098-5","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T07:25:58Z","timestamp":1783322758000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sedation-related complications during ERCP in liver transplant recipients: a retrospective cohort study"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0627-6281","authenticated-orcid":false,"given":"Nihal","family":"G\u00f6kbulut \u00d6zaslan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"\u015eahap","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gokhan","family":"Erdem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00fclent","family":"\u00d6demi\u015f","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"5098_CR1","doi-asserted-by":"publisher","first-page":"66","DOI":"10.4254\/wjh.v13.i1.66","volume":"13","author":"I Boeva","year":"2021","unstructured":"Boeva I, Karagyozov P, Tishkov I. Post-liver transplant biliary complications: current knowledge and therapeutic advances. World J Hepatol. 2021;13:66\u201379. https:\/\/doi.org\/10.4254\/wjh.v13.i1.66.","journal-title":"World J Hepatol"},{"key":"5098_CR2","doi-asserted-by":"publisher","first-page":"e928907","DOI":"10.12659\/aot.928907","volume":"26","author":"T Glowka","year":"2021","unstructured":"Glowka T, Karlstetter C, Weism\u00fcller T, Vilz T, Strassburg C, Kalff J, et al. Intensified endoscopic evaluation for biliary complications after orthotopic liver transplantation. Ann Transpl. 2021;26:e928907. https:\/\/doi.org\/10.12659\/aot.928907.","journal-title":"Ann Transpl"},{"key":"5098_CR3","doi-asserted-by":"publisher","first-page":"259","DOI":"10.14740\/gr1391","volume":"14","author":"M Alomari","year":"2021","unstructured":"Alomari M, Momani L, Alomari A, Khazaaleh S, Hitawala A, Khasawneh A, et al. The incidence of endoscopic retrograde cholangiopancreatography-related complications in patients with liver transplant: a meta-analysis and systematic review. Gastroenterol Res. 2021;14:259\u201367. https:\/\/doi.org\/10.14740\/gr1391.","journal-title":"Gastroenterol Res"},{"key":"5098_CR4","doi-asserted-by":"publisher","first-page":"459","DOI":"10.20524\/aog.2023.0801","volume":"36","author":"Z Tarar","year":"2023","unstructured":"Tarar Z, Farooq U, Gandhi M, Zafar M, Saleem S, Kamal F. Safety and indications for endoscopic retrograde cholangiopancreatography in liver transplant patients: an analysis of the United States National Inpatient Sample database. Ann Gastroenterol. 2023;36:459\u201365. https:\/\/doi.org\/10.20524\/aog.2023.0801.","journal-title":"Ann Gastroenterol"},{"key":"5098_CR5","doi-asserted-by":"publisher","DOI":"10.14309\/01.ajg.0000589960.53623.75","author":"L Momani","year":"2019","unstructured":"Momani L, Alomari M, Nehme F, Almomani S, Aasen T, Young M. The prevalence of endoscopic retrograde cholangiopancreatography-related complications in patients with liver transplant: a meta-analysis and systematic review. Am J Gastroenterol. 2019. https:\/\/doi.org\/10.14309\/01.ajg.0000589960.53623.75.","journal-title":"Am J Gastroenterol"},{"key":"5098_CR6","doi-asserted-by":"publisher","unstructured":"Zhang C, Koschny R, Rupp C, Michl P, Mehrabi A, Wehling C, et al. Post-endoscopic retrograde cholangiopancreatography cholangitis after endoscopic treatment of post-transplant biliary strictures: a retrospective study. BMC Surg. 2025;25. https:\/\/doi.org\/10.1186\/s12893-025-03106-1.","DOI":"10.1186\/s12893-025-03106-1"},{"key":"5098_CR7","doi-asserted-by":"publisher","unstructured":"Ghambari K, De Jong D, Bruno M, Polak W, Van Driel L, Hoed C. Risks of post-endoscopic retrograde cholangiopancreatography pancreatitis after liver transplantation. Clin Transpl. 2024;38. https:\/\/doi.org\/10.1111\/ctr.15399.","DOI":"10.1111\/ctr.15399"},{"issue":"2","key":"5098_CR8","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1055\/a-1075-4080","volume":"52","author":"JM Dumonceau","year":"2020","unstructured":"Dumonceau JM, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020;52(2):127\u201349. https:\/\/doi.org\/10.1055\/a-1075-4080.","journal-title":"Endoscopy"},{"key":"5098_CR9","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1055\/s-0034-1377875","volume":"46","author":"JM Dumonceau","year":"2014","unstructured":"Dumonceau JM, Andriulli A, Elmunzer BJ, Mariani A, Meister T, Deviere J, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline\u2014updated June 2014. Endoscopy. 2014;46:799\u2013815. https:\/\/doi.org\/10.1055\/s-0034-1377875.","journal-title":"Endoscopy"},{"key":"5098_CR10","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.gie.2016.02.007","volume":"153","author":"JJ Vargo","year":"2017","unstructured":"Vargo JJ, Niklewski PJ, Williams JL, et al. Patient safety during sedation by anesthesia professionals during gastrointestinal endoscopy: an analysis of 1.38 million procedures. Gastrointest Endosc. 2017;153:101\u20138. https:\/\/doi.org\/10.1016\/j.gie.2016.02.007.","journal-title":"Gastrointest Endosc"},{"issue":"4","key":"5098_CR11","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1016\/j.gie.2010.12.014","volume":"73","author":"TM Berzin","year":"2011","unstructured":"Berzin TM, Blanco PG, Lahooti A, Sylla P, Pleskow DK, Chuttani R, et al. A prospective assessment of sedation-related adverse events and patient and endoscopist satisfaction in ERCP with anesthesiologist-administered sedation. Gastrointest Endosc. 2011;73(4):710\u20137. https:\/\/doi.org\/10.1016\/j.gie.2010.12.014.","journal-title":"Gastrointest Endosc"},{"issue":"4","key":"5098_CR12","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1016\/j.gie.2018.10.045","volume":"89","author":"ZL Smith","year":"2019","unstructured":"Smith ZL, Mullady DK, Gaddam S, Cosner LK, Edmundowicz SA, Azar RR, et al. A randomized controlled trial evaluating general endotracheal anesthesia versus monitored anesthesia care and the incidence of sedation-related adverse events during ERCP in high-risk patients. Gastrointest Endosc. 2019;89(4):855\u201362. https:\/\/doi.org\/10.1016\/j.gie.2018.10.045.","journal-title":"Gastrointest Endosc"},{"issue":"1","key":"5098_CR13","doi-asserted-by":"publisher","first-page":"22781","DOI":"10.1038\/s41598-025-04922-4","volume":"15","author":"A Maieron","year":"2025","unstructured":"Maieron A, Gschwantler M, Waldner M, et al. A prospective study on incidence of desaturations in ERCP with non-anesthesiologist sedation and adverse event awareness of endoscopists. Sci Rep. 2025;15(1):22781. https:\/\/doi.org\/10.1038\/s41598-025-04922-4.","journal-title":"Sci Rep"},{"issue":"9","key":"5098_CR14","doi-asserted-by":"publisher","first-page":"3103","DOI":"10.3390\/jcm14093103","volume":"14","author":"L Obrecht","year":"2025","unstructured":"Obrecht L, Bokelmann P, Sulz MC, et al. The incidence of adverse events in adults undergoing procedural sedation with propofol administered by non-anesthetists: a systematic review and meta-analysis. J Clin Med. 2025;14(9):3103. https:\/\/doi.org\/10.3390\/jcm14093103.","journal-title":"J Clin Med"},{"issue":"4","key":"5098_CR15","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1055\/s-2007-995589","volume":"40","author":"GA Paspatis","year":"2008","unstructured":"Paspatis GA, Manolaraki MM, Vardas E, Theodoropoulou A, Chlouverakis G. Deep sedation for endoscopic retrograde cholangiopancreatography: intravenous propofol alone versus intravenous propofol with oral midazolam premedication. Endoscopy. 2008;40(4):308\u201313. https:\/\/doi.org\/10.1055\/s-2007-995589.","journal-title":"Endoscopy"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-026-05098-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-026-05098-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-026-05098-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:25:42Z","timestamp":1786447542000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12876-026-05098-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5098"],"URL":"https:\/\/doi.org\/10.1186\/s12876-026-05098-5","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]},"assertion":[{"value":"9 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the Ankara Bilkent City Hospital Clinical Research Ethics Committee. Approval Number: E1-22-2712, 29\/06\/2022. Informed consent was waived by the ethics committee due to the retrospective nature of the study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"499"}}