Sedation During Endoscopy in Patients with Cirrhosis: Safety and Predictors of Adverse Events

  • Jerome Edelson
  • Alejandro L. Suarez
  • Jingwen Zhang
  • Don C. RockeyEmail author
Original Article



Sedation during endoscopy in cirrhotic patients is typically via moderate sedation, most commonly using a combination of a benzodiazepine (i.e., midazolam) and narcotic (i.e., fentanyl) or with propofol using monitored anesthesia care (MAC). Here, we examined the safety of moderate sedation and MAC in patients with cirrhosis.


This retrospective cohort study of cirrhotic patients undergoing endoscopy from a large academic medical center between 2010 and 2014 examined extensive clinical data including the following: past history, physical findings, laboratory results, and procedural adverse events. Adverse events were defined a priori and included hypoxia, hypotension, bleeding, and death.


We identified 2618 patients with cirrhosis who underwent endoscopic procedures; the mean age was 56 years, 36% were female, the mean Child–Pugh score was 9.3 (IQR: 8, 11), and Charlson Comorbidity Index score was 3.2 (IQR: 1, 4); 1157 had MAC; and 1461 had moderate sedation. There was no difference in the frequency of adverse events in MAC and moderate sedation groups, with a total of 15 adverse events (7/1157 MAC and 8/1461 moderate sedation). The most common procedure performed was esophagogastroduodenoscopy (EGD, n = 1667) and was associated with 10 adverse events. Overall, adverse events included bradycardia (1), hypoxia (7), bleeding (5), laryngospasm (1), and perforation (1). The frequency was similar for EGD, ERCP, and colonoscopy—each at a rate of 0.6%.


Adverse events in cirrhotic patients undergoing endoscopy appeared to be similar with moderate sedation or MAC, and the frequency was the same for different types of procedures.


Adverse events Esophagogastroduodenoscopy Colonoscopy Moderate sedation Monitored anesthesia care 



The authors would like to thank Dr. Jean Craig for her assistance in helping construct the dataset for this study as well as Dr. Patrick Mauldin for his assistance in performing the statistics for this study.

Author’s contribution

Jerome Edelson contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and statistical analysis. Alejandro Suarez performed study design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and statistical analysis. Jingwen Zhang participated in analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Don Rockey contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and study oversight.



Compliance with Ethical Standards

Conflict of interest

The authors certify that we have no financial arrangements (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements, research support, honoraria, etc.) with a company whose product figures prominently in this manuscript or with a company making a competing product.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineMedical University of South CarolinaCharlestonUSA
  2. 2.Division of General Internal Medicine, Department of MedicineMedical University of South CarolinaCharlestonUSA

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