Laoveeravat P, Thavaraputta S, Suchartlikitwong S, Vutthikraivit W, Mingbunjerdsuk T, Motes A, Nugent K, Perisetti A, Tharian B, Islam S, Rakvit A. Optimal sequences of same-visit bidirectional endoscopy: Systematic review and meta-analysis.
Dig Endosc 2020;
32:706-714. [PMID:
31368170 DOI:
10.1111/den.13503]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/28/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM
Same-visit colonoscopy and esophagogastroduodenoscopy (EGD) have become common. Recent studies showed conflicting results regarding the performance, safety, and efficacy of different sequences. We conducted this meta-analysis to determine the most favorable performance and discomfort between an EGD followed by colonoscopy (E-C) and colonoscopy followed by EGD (C-E).
METHODS
The authors searched the databases of MEDLINE and EMBASE. Outcomes of interest were performance (including cecal intubation time, adenoma detection rate, and polyp detection rate), discomfort score (patients and endoscopists; Likert scale), and sedation uses. Pooled mean differences (MD) or odds ratios (OR) were calculated with 95% confidence intervals (CI).
RESULTS
Six randomized controlled trials were included in the meta-analysis. The authors found that there was significantly lower sedative use including fentanyl (14.70; 95% Cl: 8.20-21.20) and propofol (15.58; 95% Cl: 3.27-27.89) in the E-C group compared with the C-E group. There was a significantly better discomfort score in patients and endoscopists after both procedures in the E-C group than in the C-E group with pooled MD of 0.64 points (95% Cl: 0.09-1.20) and 0.47 (95% Cl: 0.05-0.90), respectively. There were no differences in cecal intubation time, adenoma detection rate, or polyp detection rate between the two groups.
CONCLUSION
The present study found that the discomfort score was better in the E-C group. However, there was no difference in polyp and adenoma detection. Therefore, the E-C group is the optimal sequence.
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