Institutional members access full text with Ovid®

Share this article on:

Anaesthetic considerations for endoscopic retrograde cholangio-pancreatography procedures

Garewal, Davinder; Vele, Liana; Waikar, Pallavi

Current Opinion in Anesthesiology: August 2013 - Volume 26 - Issue 4 - p 475–480
doi: 10.1097/ACO.0b013e3283620139

Purpose of review The purpose of this review is to evaluate the current literature on the use of general anaesthesia and propofol deep sedation for patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) procedures. Propofol is primarily an anaesthetic agent, but its use in a sedative capacity has resulted in the extensive off-label administration of this drug by gastroenterologists and other nonanaesthesia personnel. This has created controversy and enabled the gastroenterology community to gather evidence and campaign for US Food and Drug Administration approval to administer propofol to patients undergoing ERCP and other endoscopic procedures.

Recent findings General anaesthesia appears to be a well tolerated technique for patients undergoing ERCP procedures, although there is a scarcity of publications in this field. The available evidence from prospective and retrospective cohort studies suggests a low incidence of serious outcomes (from sedation-related incidents) in patients undergoing ERCP procedures under propofol deep sedation. However, data from the American Society of Anesthesiologists closed claims analysis report suggests that endoscopy procedures performed under monitored anaesthetic care using propofol as a sedative agent can result in serious patient harm.

Summary Deep sedation with propofol, administered by anaesthesia personnel, can be used as an alternative to general anaesthesia for a select group of patients undergoing ERCP procedures. Further research is necessary to clarify the nature and parameters of deep sedation.

St George's Hospital, Tooting, London, UK

Correspondence to Davinder Garewal, FRCA, MbChB, St George's Hospital, Tooting, London SW17 0QT, UK. Tel: +442086721255; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.