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P509 What is the effect of inflammatory bowel disease on sedation rates at colonoscopy?

M. Walshe*, C. Moran, G. Horgan, G. Cullen, H. Mulcahy, G. Doherty

St Vincent’s University Hospital, Department of Gastroenterology and Centre for Colorectal Disease, Dublin, Ireland

Background

Full colonoscopy is used to assess disease extent and activity in inflammatory bowel disease (IBD). There has been very little study on sedation requirements of IBD patients at colonoscopy. The aims of our study were as follows:

To assess whether IBD is associated with increased sedation at colonoscopy

To assess whether sedation rates differ amongst Crohn’s disease (CD) vs ulcerative colitis (UC) patients

To assess the effect of disease activity on sedation rates in IBD patients

Methods

Data were retrieved from EndoRad, our electronic endoscopy reporting system. We analysed data relating to full colonoscopies performed between January 2013 and August 2015. Colonoscopies which failed to reach the caecum, or were performed for stricture dilation, were excluded. We compared sedation administered in IBD vs non-IBD patients, assessing the proportion of colonoscopies at which > 5 mg midazolam and ≥ 100 mcg fentanyl was administered. For colonoscopies performed in IBD patients, we used similar methods to compare sedation use in UC vs CD, and in patients with active IBD endoscopically vs those with quiescent disease. Data analysis was performed using SPSS (version 18). Proportions were compared using Chi-squared models. Results are reported as odds ratios, with 95% confidence intervals and p-values.

Results

Data relating to 6 595 colonoscopies were analysed; 646 (9.8%) in IBD patients, 5 949 (90.2%) in non-IBD patients. More than 5 mg of midazolam was administered at 169 (26.2%) colonoscopies performed in IBD patients vs 895 (15.1%) in non-IBD patients, (OR 2.0, 95% CI 1.7–2.4, p < 0.001). At least 100 mcg of fentanyl was given at 278 (43.0%) colonoscopies in IBD patients vs 1786 (30.0%) in non-IBD patients, (OR 1.8, 95% CI 1.5–2.1, p < 0.001). In total, 314 colonoscopies were performed in CD patients, and 332 colonoscopies were performed in UC patients. More than 5 mg midazolam was administered at 99 (31.5%) colonoscopies in CD patients vs 70 (21.1%) in UC patients, (OR 1.7, CI 1.2–2.5, p = 0.003). At least 100 mcg fentanyl was given at 155 (49.4%) colonoscopies in CD patients vs 123 (37.0%) in UC patients, (OR 1.7, 95%CI 1.2–3.3, p = 0.002). Amongst colonoscopies performed in IBD patients, active disease was evident endoscopically in 374(57.9%) (no active disease in 272 [42.1%]). More than 5 mg midazolam was administered at 101 (27.0%) colonoscopies showing active IBD vs 68 (25.0%) not showing active IBD, (p = 0.567). At least 100 mcg fentanyl was given at 160 (42.8%) colonoscopies showing active IBD vs 118(43.4%) not showing active IBD, (p = 0.879).

Conclusion

Presence of IBD and Crohn’s subtype is associated with higher dosing of both midazolam and fentanyl at full colonoscopy. IBD disease activity does not have an effect on sedation use at full colonoscopy.