Randomized controlled trial of procedural sequence for same-day bidirectional endoscopy under monitored anesthesia care (recover trial)

Background and AimsEvidence regarding the ideal endoscopy sequence is inconclusive in patients undergoing same-day bidirectional endoscopy (BDE).MethodsAdults undergoing endoscopy with moderate sedation were randomized to either colonoscopy first (C-E) or EGD first (E-C) under monitored anesthesia care and bispectral index (BIS) monitoring. The primary endpoint was time to recovery from sedation. Secondary endpoints were total amount of sedative, time in deep sedation (defined as BIS <60), patient and endoscopist satisfaction, and adverse events. Patients were contacted the following day for assessment of postdischarge events including delayed recovery and effects on cognitive function and memory.ResultsOne hundred twenty consecutive patients were enrolled (60 per arm). Baseline characteristics were similar. There was no difference between the C-E and E-C groups in time to recovery (20.2 ± 8.8 minutes vs 17.9 ± 8.8 minutes), dose of propofol (219.9 ± 79.6 mg vs 217.6 ± 79.1 mg), total time spent in deep sedation (7.2 ± 6.6 minutes vs 9.5 ± 7.9 minutes), patient and endoscopist satisfaction, adenoma detection rate (38.3% vs 31.7%, P = .444), intraprocedural adverse events, or immediate adverse events. Time to reach the cecum was shorter for E-C patients (5.9 ± 3.5 minutes vs 7.3 ± 3.78 minutes, P = .033), whereas C-E patients reported higher rates of postdischarge dizziness (17.5% vs 3.5%, P = .015).ConclusionsThere are no clinically significant differences between procedural sequences in same-day BDE. Decisions regarding the preferred sequence may be individualized, taking into consideration procedural yield, individual risk, and other factors such as the potential for aerosol generation and staff exposure. (Clinical trial registration number: NCT04096339.) Evidence regarding the ideal endoscopy sequence is inconclusive in patients undergoing same-day bidirectional endoscopy (BDE). Adults undergoing endoscopy with moderate sedation were randomized to either colonoscopy first (C-E) or EGD first (E-C) under monitored anesthesia care and bispectral index (BIS) monitoring. The primary endpoint was time to recovery from sedation. Secondary endpoints were total amount of sedative, time in deep sedation (defined as BIS <60), patient and endoscopist satisfaction, and adverse events. Patients were contacted the following day for assessment of postdischarge events including delayed recovery and effects on cognitive function and memory. One hundred twenty consecutive patients were enrolled (60 per arm). Baseline characteristics were similar. There was no difference between the C-E and E-C groups in time to recovery (20.2 ± 8.8 minutes vs 17.9 ± 8.8 minutes), dose of propofol (219.9 ± 79.6 mg vs 217.6 ± 79.1 mg), total time spent in deep sedation (7.2 ± 6.6 minutes vs 9.5 ± 7.9 minutes), patient and endoscopist satisfaction, adenoma detection rate (38.3% vs 31.7%, P = .444), intraprocedural adverse events, or immediate adverse events. Time to reach the cecum was shorter for E-C patients (5.9 ± 3.5 minutes vs 7.3 ± 3.78 minutes, P = .033), whereas C-E patients reported higher rates of postdischarge dizziness (17.5% vs 3.5%, P = .015). There are no clinically significant differences between procedural sequences in same-day BDE. Decisions regarding the preferred sequence may be individualized, taking into consideration procedural yield, individual risk, and other factors such as the potential for aerosol generation and staff exposure. (Clinical trial registration number: NCT04096339.)