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Optimal sequences of same‐visit bidirectional endoscopy: Systematic review and meta‐analysis
Author(s) -
Laoveeravat Passisd,
Thavaraputta Subhanudh,
Suchartlikitwong Sakolwan,
Vutthikraivit Wasawat,
Mingbunjerdsuk Thammasak,
Motes Arunee,
Nugent Kenneth,
Perisetti Abhilash,
Tharian Benjamin,
Islam Sameer,
Rakvit Ariwan
Publication year - 2020
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13503
Subject(s) - medicine , colonoscopy , esophagogastroduodenoscopy , sedation , meta analysis , odds ratio , confidence interval , withdrawal time , intubation , randomized controlled trial , adenoma , endoscopy , gastroenterology , surgery , colorectal cancer , cancer
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.