İleri Düzey Endoskopide Sedasyon Güvenliği: ERCP ve EUS İşlemlerinin Karşılaştırmalı Analizi

Abstract

Amaç: Bu çalışmada, endoskopik retrograd kolanjiyopankreatografi (ERCP) ve endoskopik ultrasonografi (EUS) işlemleri sırasında gelişen sedasyon ilişkili advers olayların karşılaştırılması ve işlem sırasında gelişen hipokseminin prediktörlerinin belirlenmesi amaçlandı.

Gereç ve Yöntemler: Bu retrospektif tek merkezli çalışmaya, Ocak 2015 ile Aralık 2025 tarihleri arasında sedasyon altında ERCP veya EUS uygulanan 236 erişkin hasta dahil edildi. Primer sonlanım, SpO₂ <%90 olarak tanımlanan işlem sırasındaki hipoksemiydi. Sekonder sonlanımlar ciddi hipoksemi, havayolu müdahalesi, işlem kesintisi, hipotansiyon, bradikardi, havayolu yönetiminde eskalasyon ve plansız post-prosedürel gözlemi içeriyordu. Hipoksemi prediktörlerini belirlemek için lojistik regresyon analizi kullanıldı.

Bulgular: ERCP 128 hastaya, EUS ise 108 hastaya uygulandı. Başlangıç klinik ve demografik özellikler gruplar arasında benzerdi. ERCP işlemleri daha uzun sürdü ve prone veya semi-prone pozisyonda daha sık gerçekleştirildi. Sedasyon ilişkili advers olaylar ERCP grubunda EUS grubuna göre daha sık görüldü (%28,9’a karşı %13,9; p=0,006). Hipoksemi (%18,8’e karşı %7,4; p=0,011) ve havayolu müdahalesi gereksinimi (%14,8’e karşı %5,6; p=0,021) de ERCP grubunda daha yüksekti. Çok değişkenli analizde ERCP işlemi, ASA III–IV durumu, kronik pulmoner hastalık, işlem süresinin >60 dakika olması, ek sedatif gereksinimi ve düşük başlangıç SpO₂ değeri hipoksemi ile bağımsız olarak ilişkili bulundu.

Sonuç: ERCP, EUS’a kıyasla daha fazla sedasyon ilişkili solunumsal olay ile ilişkili bulundu. Hipoksemi riskinin hem hasta ilişkili hem de işlem ilişkili faktörlerden etkilendiği görüldü. Özellikle ERCP sırasında dikkatli işlem öncesi risk değerlendirmesi ve yakın solunumsal monitörizasyon sedasyon güvenliğini artırabilir.

Keywords

• ERCP
• EUS
• sedasyon
• hipoksemi
• havayolu müdahalesi
• ileri endoskopi

Ethical Statement

Bu çalışma, Düzce Üniversitesi Non-Interventional Klinik Araştırma Etik Kurulu tarafından onaylanmıştır (onay numarası: 2026/147; tarih: 27 Nisan 2026). Çalışma, Helsinki Bildirgesi’ne uygun olarak yürütülmüştür. Çalışmanın retrospektif tasarımı nedeniyle, bilgilendirilmiş onam şartından feragat edilmiştir.

Sedation Safety in Advanced Endoscopy: A Comparative Analysis of ERCP and EUS Procedures

Abstract

Aim: This study aimed to compare sedation-related adverse events between endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) and to identify predictors of intra-procedural hypoxemia.

Material and Methods: This retrospective single-center study included 236 adults who underwent ERCP or EUS under sedation between January 2015 and December 2025. The primary outcome was intra-procedural hypoxemia, defined as SpO₂ <90%. Secondary outcomes included severe hypoxemia, airway intervention, procedure interruption, hypotension, bradycardia, escalation of airway management, and unplanned post-procedural observation. Logistic regression analysis was used to determine predictors of hypoxemia.

Results: ERCP was performed in 128 patients and EUS in 108 patients. Baseline characteristics were comparable between groups. ERCP procedures were longer and more frequently performed in the prone or semi-prone position. Sedation-related adverse events were more common in ERCP than EUS (28.9% vs. 13.9%, p=0.006). Hypoxemia (18.8% vs. 7.4%, p=0.011) and airway intervention requirement (14.8% vs. 5.6%, p=0.021) were also higher in the ERCP group. In multivariable analysis, ERCP procedure, ASA III–IV status, chronic pulmonary disease, procedure duration >60 minutes, additional sedative requirement, and lower baseline SpO₂ were independently associated with hypoxemia.

Conclusion: ERCP was associated with more sedation-related respiratory events than EUS. Hypoxemia risk appeared to be influenced by both patient- and procedure-related factors. Careful pre-procedural risk assessment and close respiratory monitoring may improve sedation safety, particularly during ERCP.

Keywords

• ERCP
• EUS
• sedation
• hypoxemia
• airway intervention
• advanced endoscopy

Ethical Statement

This study was approved by the Non-Interventional Clinical Research Ethics Committee of Düzce University (approval number: 2026/147; date: April 27, 2026). The study was conducted in accordance with the Declaration of Helsinki. Due to the retrospective design, the requirement for informed consent was waived.

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