Safety and Efficacy of Moderate Sedation in Super Obese Patients Undergoing Lower and Upper GI Endoscopy: a Case-Control
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ORIGINAL CONTRIBUTIONS
Safety and Efficacy of Moderate Sedation in Super Obese Patients Undergoing Lower and Upper GI Endoscopy: a Case-Control Study Mark Benson 1 & Jeffrey Hubers 1 & Matthew Caldis 2 & Deepak Gopal 1 & Patrick Pfau 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Obesity is a disease of increasing prevalence. There is minimal research on the safety of sedation for general endoscopic procedures among super obese patients (BMI ≥ 50). The aim of our study was to evaluate the safety of moderate sedation and endoscopic procedural outcomes for super obese patients in a case-control study. Materials and Methods We completed an age and sex–matched case-control study comparing 132 super obese patients with 132 non-obese controls. We assessed intra-procedure adverse events, delayed adverse events, doses of sedation medication used, and procedure duration at a tertiary care setting. Results The mean BMI for the obese cohort was 55.6 compared with 22.5 for the controls (P < 0.001). The mean intra-procedure fentanyl and midazolam dose was higher for the obese patients compared with the controls, fentanyl 180 mcg, midazolam 7.7 mg vs fentanyl 148 mcg, midazolam 6.4 mg, respectively (P < 0.001). There was a significantly higher percentage of brief intraprocedure hypoxia (oxygen blood saturation < 90%) for the obese patients compared with the controls, 5% vs 0% (P = 0.02). There was no difference in delayed adverse events with 2% of the cases and 2% of the controls having delayed adverse events (P = 1.0). Procedure completion rates were 100% for both cases and controls. Conclusion General endoscopic procedures can be safely and effectively performed in super obese patients with moderate sedation. Brief intra-procedure hypoxia more commonly occurs in super obese patients, and higher medication doses are required. Keywords Obesity . Moderate sedation . Safety of endoscopy
Background The incidence of obesity and its associated comorbid diseases are increasing globally at an alarming rate [1]. Within the USA, approximately 35% of men and 40% of women are obese [2, 3]. Morbid obesity denotes individuals with a BMI ≥ 40 kg/m2, while the term super obese has been used to categorize individuals with a BMI ≥ 50 kg/m2 [4]. The prevalence of extreme obesity in the USA is estimated to be 7.6%
* Mark Benson [email protected] 1
Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Room 4240-01A MFCB, Madison, WI 53705, USA
2
Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
[5, 6].With the increase in obesity prevalence, there is a growing demand for gastroenterologists to complete endoscopic procedures on super obese patients. Despite this growing demand, there is a paucity of data evaluating the safety of sedation for endoscopic procedures in this patient population. Esophagogastroduodenoscopy (EGD) and colonoscopy are two of the most com
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