Viabilidad de la enteroscopia monobalón realizada bajo sedación dirigida por endoscopista / Viability of single balloon enteroscopy performed under endoscopist-directed sedation

RESUMEN

Introducción: existe controversia sobre quién debe responsabilizarse de la sedación en endoscopia digestiva, sobre todo en los procedimientos avanzados que exigen sedación profunda. La enteroscopia es uno de ellos. El objetivo del trabajo es valorar la viabilidad de la sedación controlada por endoscopista durante la enteroscopia de monobalón. Material y método: estudio prospectivo observacional de una serie de enteroscopias consecutivas. Personal dedicado endoscopista, enfermera instrumentista y enfermera encargada de monitorización y administración de sedantes. Monitorización pulsioximetría, tensión arterial cada cinco minutos, registro electrocardiográfico y frecuencia respiratoria. Administración continua de oxígeno. Insuflación con CO2. Posición del paciente decúbito izquierdo. Control fluoroscópico. Resultados: cuarenta y cuatro exploraciones en 39 pacientes (24 hombres, 15 mujeres). Edad 74 (18-89). Grado ASA I-12, II-23, III-9. Comorbilidades en el 68% de los casos. Fármacos empleados propofol, 23 casos; propofol y midazolam, diez casos; propofol, midazolam y fentanilo, dos casos; propofol y fentanilo, dos casos; y midazolam y fentanilo, siete casos. Procedimientos completados 100%. Tiempo de exploración 52 minutos (20-120). Hallazgos diagnósticos en el 65,9% de los casos; maniobras terapéuticas en el 47,7%. Complicaciones graves ninguna. Complicaciones menores derivadas de la sedación 22,7%. Conclusión: la sedación controlada por endoscopista es eficaz y segura en la realización de enteroscopia con monobalón. Son convenientes estudios multicéntricos y con mayor número de casos para una mejor valoración de la eficacia, seguridad y eficiencia de la sedación por no anestesista en endoscopia avanzada en nuestro medio

ABSTRACT

Introduction: there is a lot of controversy with regard to who should be responsible for sedation during digestive endoscopy, particularly in advanced procedures that require deep sedation such as enteroscopy. The aim of this study was to evaluate the endoscopist-directed sedation viability during single balloon enteroscopy. Material and method: this was a prospective, observational study of a series of consecutive enteroscopies. The clinical staff included an endoscopist, scrub nurse and a nurse in charge of monitoring and sedative administration. The following parameters were monitored pulse oximetry, blood pressure (every five minutes), electrocardiogram and respiratory rate. There was continuous supplemental oxygen and CO2 insufflation. The patient was in the left lateral decubitus position and a fluoroscopic control was used. Results: forty-four explorations were performed in 39 patients, 24 were male and 15 female. The median age was 74 (18-89) and the ASA score was I in 12 cases, II in 23 cases and III in nine cases. Comorbidities were present in 68% of cases. The drugs used included propofol in 23 cases, propofol and midazolam in ten cases, propofol/midazolam/fentanyl in two cases, propofol and fentanyl in two cases, and midazolam/fentanyl in seven cases. All procedures were complete. The length of the procedure was 52 minutes (20-120). There were diagnostic findings in 65.9% of cases and therapeutic measures in 47.7%. There were no severe complications and the rate of complications derived from sedation was 22.7%. Conclusion: endoscopist-directed sedation is effective and safe for single balloon enteroscopy. Multi-center and wider studies are needed in order to better assess the efficacy, safety and efficiency of sedation controlled by a non-anesthetist during advanced endoscopy in this field