Safety and sedation-associated adverse event reporting among patients undergoing endoscopic cholangiopancreatography: a comparative systematic review and meta-analysis

Background and aim: There is wide variation in choice of sedation and airway management for endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to perform a systematic review and meta-analysis to investigate safety outcomes of deep sedation with monitored anesthesia care (MAC) versus general endotracheal anesthesia (GETA). Methods: Individualized search strategies were performed in accordance with PRISMA and MOOSE guidelines. This meta-analysis was performed by calculating pooled proportions using random effects models. Measured outcomes included procedure success, all-cause and anesthesia-associated adverse events, and post-procedure recovery time. Heterogeneity was assessed with I² statistics and publication bias by funnel plot and Egger regression testing. Results: Five studies (MAC: n = 1284 vs GETA: n = 615) were included. Patients in the GETA group were younger, had higher body mass index (BMI), and higher mean ASA scores (all P < 0.001) with no difference in Mallampati scores (P = 0.923). Procedure success, all-cause adverse events, and anesthesia-associated events were similar between groups [OR 1.16 (95% CI 0.51–2.64); OR 1.16 (95% CI 0.29–4.70); OR 1.33 (95% CI 0.27–6.49), respectively]. MAC resulted in fewer hypotensive episodes [OR 0.32 (95% CI 0.12–0.87], increased hypoxemic events [OR 5.61 (95% CI 1.54–20.37)], and no difference in cardiac arrhythmias [OR 0.48 (95% CI 0.13–1.78)]. Procedure time was decreased for MAC [standard difference − 0.39 (95% CI − 0.78–0.00)] with no difference in recovery time [standard difference − 0.48 (95% CI − 1.04–0.07)]. Conclusions: This study suggests MAC may be a safe alternative to GETA for ERCP; however, MAC may not be appropriate in all patients given an increased risk of hypoxemia.