Is endoscopist-directed sedation for endoscopic retrograde cholangiopancreatography with balanced propofol solution (BPS) practical and safe? A prospective study from a tertiary care centre in India

Introduction
Endoscopist-directed, nurse-administered sedation using propofol, midazolam, and fentanyl for endoscopic retrograde cholangiopancreatography (ERCP) is being utilized worldwide. However, this is not usually employed in India by endoscopists.

Aim: To assess the efficacy, acceptability, and safety of this sedation in low to moderate risk patients undergoing ERCP.

Material and methods
This was a prospective study involving 500 patients with any indication for ERCP. The sedation was given by trained nurses.

Results
The sedative dosages per patient were as follows: propofol = 90 ±20 mg, fentanyl 0.75 ±0.25 mg (range: 0.25–1.00 mg), and midazolam 2 ±0.5 mg (range: 1–3 mg). Ninety-seven percent of patients achieved Richmond agitation sedation score of ≥ –3, and 96.8% achieved Gloucester comfort score of ≤ 2. 4.22% of the patients had mild adverse events (AE), and 2.11% had moderate AE. Two (0.4%) patients required intubation and intensive care unit admission. Mean recovery time was 15.3 min. 98.3% of the endoscopists were satisfied with the sedation achieved. 31.2% of the patients remembered the procedure. 93% of the patients were satisfied with the type of sedation. 92.75% of ERCPs were successful. 7.59% had procedure-related complications: in the form PEP – 5.290%, significant bleeding – 1.08%, and perforation – 0.43%.

Conclusions
Endoscopist-directed, nurse-administered sedation for ERCP with balanced propofol solution is practical, efficient, time saving, safe, and acceptable to patients.