Introduction Worldwide, gastrointestinal endoscopies are predominantly performed under sedation. National and international guidelines and recommendations contain very different specifications for the use of sedation in gastrointestinal endoscopy. These differences come from specific requirements for staffing during endoscopy. Aim The aim of the study is to evaluate whether endoscopist-guided sedation without additional sedation assistance is not inferior to endoscopist-guided sedation with additional sedation assistance with respect to the rate of sedation-associated complications in a defined low-risk population (low-risk procedure and low-risk patient). Methods Prospective, multicenter, randomized study. Results 27 German study centers participated in the study. A total of 30 569 endoscopies were recorded during the study period from 1.8.2015 to 10.3.2020. The final data analysis included 28 673 examinations (64.1 % esophagosgastroduodenoscopies and 35.9 % colonoscopies). In 307 (1.1 %) examinations, 322 sedation-associated complications occurred. Of these, 321 (1.1 %) were minor complications and one (0.003 %) was a major complication. There was no statistically significant difference in the frequency of sedation-associated complications between endoscopist-guided sedation with versus without additional sedation assistance. Within the legal framework, a "shadow " sedation assistant was present in the study group without sedation assistance. This assistant intervened because of sedation-associated complications in 101 (0.7 %) of the endoscopies. Conclusion The study documents the safety of propofol-based endoscopist-guided sedation in a low-risk population. In 98.9 % of all endoscopies, no sedation-associated complication occurred or it was so minimal that no intervention (e. g., increase of oxygen supply) was necessary. The study cannot answer to what extent a serious complication was avoided by the active intervention of the "shadow " sedation assistance in the group without sedation assistance.The study proves in a randomized, prospective design that sedation in low-risk endoscopy (low-risk patient, low-risk procedure) can be performed as endoscopist-guided sedation without additional sedation assistance, without demonstrably accepting a reduction in safety.

Prof. Dr. med. Jürgen F. Riemann ist einer der bedeutendsten Visionäre und Vorkämpfer der Prävention des kolorektalen Karzinoms. Das unter seiner Federführung mitentwickelte Vorsorgekonzept, unter anderem mit der Vorsorgekoloskopie ab dem 55. Lebensjahr, gilt anderen europäischen Ländern nach wie vor als Vorbild. Für den vorliegenden Widmungsbeitrag wurde daher bewusst das Thema Darmkrebsvorsorge ausgewählt.

Persons with a familial risk of colorectal cancer (CRC) account for about 25% of all CRC cases. The adenoma prevalence in relatives of CRC patients 50–60 years of age is 17–34%; data on younger individuals are scarce. Our aim was to prospectively define the adenoma prevalence in 40- to 50-year-old first-degree relatives of CRC patients compared to controls.

The aim of our prospective randomized study involving 100 patients was to investigate whether Doppler ultrasound can be used to select patients at risk for ulcer rebleeding. Ulcers in the Forrest group classified as having a visible vessel or a clot were treated prophylactically by injection with epinephrine solution. In the Doppler group, in contrast, only ulcers with a positive Doppler signal were treated endoscopically. In the Doppler group, rebleeds occurred significantly less frequently (2%, P < 0.03) than in the Forrest group (14%). Emergency surgery was only necessary in the Forrest group (0% vs 5%; P = 0.02). Bleeding-related mortality was 0% and 4% (P = 0.15) and the overall mortality 0% and 10% (P = 0.02), in the Doppler and Forrest groups, respectively. These results appear to show that Doppler-based injection treatment is superior to endoscopic treatment based exclusively on the Forrest classification. In our study, Doppler-based local endoscopic treatment reduced the danger of a rebleed and thus the number of emergency operations and the overall mortality.