Preferences and determinants of procedural sequencing in bidirectional endoscopy among anesthesiologists

Year 2025, Volume: 16 Issue: 1, 150 - 158, 25.03.2025

Caner Genç , Sezgin Bilgin , Hasan Çetinkaya , Hatice Selçuk Kuşderci , Sevda Akdeniz , Esra Turunç , Burhan Dost , Özgür Kömürcü

https://doi.org/10.18663/tjcl.1646691

Abstract

Aim: This study aims to evaluate anesthesiologists’ preferences regarding procedural sequencing in bidirectional endoscopy
(esophagogastroduodenoscopy [EGD] and colonoscopy) and to identify the factors influencing these preferences.
Material and Methods: This descriptive and cross-sectional survey was conducted online between November and December 2024 among anesthesiologists experienced in non-operating room anesthesia practices across Turkey. A total of 204 anesthesiologists actively working in endoscopy units and experienced in bidirectional endoscopy participated in the study. The survey included questions on demographic information, clinical practices, procedural sequence preferences, and the reasons behind these preferences. Statistical analysis was performed using SPSS version 22.0, with categorical variables analyzed using the Pearson Chi-Square test, and a p-value of <0.05 was considered statistically significant.
Results: Among the participants, 63.7% reported starting bidirectional endoscopies with EGD, 15.7% preferred beginning with colonoscopy, and 20.6% indicated no specific procedural order. The choice of procedural sequence was significantly associated with the anesthesiologist’s age (p=0.010), type of institution (p=0.002), and professional experience. The most commonly used intravenous sedatives were propofol (99.0%), midazolam (86.3%), and fentanyl (58.8%). Key factors influencing the choice of procedural order included the endoscopist’s preference (69.1%), equipment availability (56.4%), and considerations regarding airway management safety (30.9%). The most frequently reported complication was respiratory depression (51.5%), with no statistically significant difference in complication rates based on procedural sequence (p>0.05).
Conclusion: Various patient-related and environmental factors influence anesthesiologists’ preferences for procedural sequencing in bidirectional endoscopy. While starting with EGD is the most common approach, patient safety and team dynamics are critical determinants of procedural choices. These findings highlight the importance of multidisciplinary teamwork and the consideration of patient characteristics in optimizing procedural safety and success.

Keywords

bidirectional endoscopy, esophagogastroduodenoscopy, colonoscopy, procedural sequence, anesthesia management

Anestezistlerin bidirectional endoskopi işlemlerinde prosedür sırası tercihleri ve belirleyici faktörler

Abstract

Amaç: Bu çalışmanın amacı, bidirectional endoskopi işlemlerinde (özofagogastroduodenoskopi [ÖGD] ve kolonoskopi)
anestezistlerin prosedür sırası tercihlerini ve bu tercihlere etki eden faktörleri değerlendirmektir.
Gereç ve Yöntemler: Tanımlayıcı ve kesitsel tasarımda yürütülen bu anket çalışması, Kasım-Aralık 2024 tarihleri arasında Türkiye genelinde ameliyathane dışı anestezi uygulamalarında deneyimli anestezistlere çevrim içi platformlar aracılığıyla uygulanmıştır. Çalışmaya, endoskopi ünitelerinde aktif görev alan ve bidirectional endoskopi konusunda deneyimli 204 anestezist katılmıştır. Anket formu, katılımcıların demografik bilgileri, klinik pratikleri, prosedür sırası tercihleri ve tercih nedenlerini sorgulayan sorulardan oluşmuştur. Verilerin istatistiksel analizi SPSS 22.0 programı kullanılarak gerçekleştirilmiş, kategorik değişkenler Pearson Ki-Kare testi ile değerlendirilmiş ve p<0,05 anlamlı kabul edilmiştir.
Bulgular: Katılımcıların %63,7’si bidirectional endoskopilere ÖGD ile başlandığını belirtirken, %15,7’si kolonoskopiyi tercih etmiş, %20,6’sı ise belirli bir işlem sırası olmadığını ifade etmiştir. İşlem sırası tercihi; anestezistin yaşı (p=0,010), çalıştığı kurum türü (p=0,002) ve mesleki deneyimi ile ilişkili bulunmuştur. En sık tercih edilen intravenöz sedatif ajanlar propofol (%99,0), midazolam (%86,3) ve fentanil (%58,8) olmuştur. İşlem sırası tercihini etkileyen başlıca faktörler arasında endoskopistin tercihi (%69,1), ekipman uygunluğu (%56,4) ve hava yolu yönetimi güvenliği (%30,9) yer almıştır. Komplikasyonlar arasında en sık solunum depresyonu (%51,5) gözlenmiş olup, işlem sırasına göre komplikasyon oranlarında anlamlı fark saptanmamıştır (p>0,05).
Sonuç: Anestezistlerin bidirectional endoskopide işlem sırası tercihleri çeşitli hasta ve çevresel faktörlerden etkilenmektedir. Çoğu anestezist, hasta güvenliği ve ekip dinamiklerini göz önünde bulundurarak işlem sırası olarak ÖGD ile başlamayı tercih etmektedir. Elde edilen bulgular, multidisipliner ekip çalışmasının ve hasta özelliklerinin dikkate alınmasının, hasta güvenliği ve prosedürel başarı açısından önemini vurgulamaktadır.

Keywords

bidirectional endoskopi, özofagogastroduodenoskopi, kolonoskopi, prosedür sırası, anestezi yönetimi

Ethical Statement

Samsun Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan GOKAEK 2024/19/3 sayı numarası ile etik kurul onayı alınmıştır.

Thanks

Bu çalışmanın planlanması ve yürütülmesinde değerli katkılarından dolayı Doç. Dr. Özgür Kömürcü’ye ve Doç. Dr. Sezgin Bilgin’e teşekkür ederiz.

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