Gastroenterology

There are three major classes of gastroenterology (GI) procedures that are performed using anesthesia services: colonoscopy/sigmoidscopy (lower GI scope, flex sig), esophagogastroduodenoscopy (EGD, upper GI scope) and endoscopic imaging studies (ERCP, EUS). The anesthesia provider is managing the risk of aspiration (breathing stomach contents), the speed of the procedure and the level of stimulation. Most commonly for GI procedures, propofol is used as it is a fast-on and fast-off drug with minimal residual side effects post-procedurally. Additionally, this may be combined with other medications such as opiates or other analgesics. If a breathing tube is placed, then the anesthesia may be an inhaled volatile anesthesia agent (as is common in most surgeries).

Lower GI endoscopy

For colonoscopies and flexible sigmoidoscopies, patients usually lie on their left hand side (left-lateral decubitus). The anesthesia provider will provide sedation with a target of moderate sedation. There is usually no need for an airway device (breathing tube). The proceduralist inserts the scope in the rectum after the patient is adequately sedated. These procedures can last from 10-30 minutes depending on the extent of the examination and the number of biopsies/bands needed.

Upper GI endoscopy

For the EGD, patients usually lie on their left hand side (left-lateral decubitus). The anesthesia provider will provide sedation with a target of deep sedation or will choose general anesthesia. The gag reflex is very present with the EGD and needs to be overcome in order for the proceduralist and patient to be comfortable. Therefore, with the EGD, there is a higher likelihood of needing airway device (breathing tube). The scope is inserted in the mouth after adequate sedation, and therefore the airway is not as easily accessible to the anesthesia provider (hence the increased likelihood of a breathing device). These procedures can last from 15-40 minutes depending on the extent of the examination and the number of biopsies/bands needed.

Advanced GI endoscopy

For the endoscopic imaging studies, patients usually lie on their belly (prone) with their head turned to the side. Two types of studies include endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). These two imaging studies can be thought of as extensions of the EGD procedure with additional imaging, so they will be more complex than the EGD. The anesthesia provider will provide sedation with a target of deep sedation or will choose general anesthesia. With the ERCP/EUS, there is a high likelihood of needing airway device (breathing tube). The scope is inserted in the mouth after adequate sedation, and therefore the airway is not easily accessible to the anesthesia provider. These procedures can last from 30-90 minutes depending on the extent of the examination and the number of biopsies or tehnical difficulty of placing stents.