What is the Effect of IBD on Sedation rates at Colonoscopy?
Dr. M. Walshe, Dr. G. Doherty
St. Vincent’s University Hospital, Dublin 4
Full colonoscopy is used to assess disease extent and activity in IBD patients. There has been very little study on sedation requirements of IBD patients at colonoscopy.
To assess whether IBD is associated with increased sedation at colonoscopy. To assess differences in sedation rates amongst U.C. vs Crohn’s patients. To assess the effect of disease activity on sedation rates in IBD patients.
Data was retrieved from EndoRad, our electronic endoscopy reporting system. We analysed data relating to full colonoscopies performed between January 2013 and August 2015. We compared sedation rates for colonoscopies in IBD vs non-IBD patients, assessing the proportion receiving >5mg midazolam and >50mcg fentanyl. Within our IBD group, we analysed sedation rates for U.C. vs Crohn’s, and for patients with moderate/severe disease activity versus inactive/mild disease activity.
In total, 7,171 full colonoscopies were performed, of which 752 were in IBD patients. For colonoscopies in non-IBD patients, 18.6% received >5mg midazolam, whilst 30.2% of IBD patients received >5mg midazolam, p=<0.0001. For non-IBD patients, 42.7% received >50mcg fentanyl vs 60.1% IBD patients, p=<0.0001. In patients with Crohn’s disease, 37.2% received >5mg midazolam vs 23.5% U.C. patients, p=0.0002. In Crohn’s patients, 66.9% received >50mcg fentanyl vs 55.4% U.C. patients, p=0.0024. Amongst patients with moderate/severe IBD disease activity, 31.8% received >5mg midazolam, vs 29.6% pts with inactive/mild disease activity, p=0.58. Amongst patients with moderate-severe activity, 65.6% received >50mcg fentanyl vs 58.1% patients with inactive/mild disease.
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 impact on sedation use at full colonoscopy.