S1234 Proceduralist-Directed Sedation vs Anesthesia Care Team Sedation for Outpatient GI Endoscopy: A Retrospective Comparative Study

Introduction: Proceduralist-directed sedation (PDS) is increasingly utilized to meet the rising demand for gastrointestinal procedures, offering rapid onset and recovery with propofol. Anesthesia care team (ACT) sedation, the traditional alternative, is still used for higher-risk patients. However, comparative data on sedation efficiency, drug wastage, and complication rates remain limited. Methods: We conducted a retrospective chart review of consecutive outpatient endoscopic procedures at our tertiary care center and classified them into PDS and ACT cohorts. Only procedures using Propofol were included, and procedures with advanced interventions (e.g., POEM, ablations) were excluded. Data on baseline demographic characteristics, type and dosage of sedation used, and any post-procedural complications were collected, and using the Pearson's Chi-Square Test and Kruskal-Wallis Test, on the BlueSky Statistics Version 10.3.4. A significance level of P < 0.05 was applied. Results: Of a total of 292 outpatient procedures, 240 procedures (PDS = 190; ACT = 50) were included. PDS patients were younger [52.13 years vs 58.28 years (P = 0.004)] and had significantly lower ASA and Mallampati scores. No significant differences were seen for gender, race, substance use, BMI, or the type of procedure. With propofol coming in a 200 mg vial, propofol wastage occurred less frequently in the PDS cohort (59.5% vs 90%, P < 0.001), although the amount wasted was not statistically significant (95.52 mg vs 105.11 mg, P = 0.11). Other sedatives used along with propofol in the 2 cohorts were significantly different, with a higher usage of midazolam (P < 0.001) in the PDS cohort, and fentanyl (P < 0.001) and lidocaine (P < 0.001) having a higher usage in the ACT cohort. Sedation-related complications were more commonly seen in the ACT cohort (28% vs 1.6%, P < 0.001), with hypoxia requiring interventions (22% vs 0.5%, P < 0.001) being the most common. One patient in the ACT developed aspiration pneumonia and required readmission. Conclusion: PDS is a safe and effective alternative to ACT sedation for outpatient endoscopy, with significantly fewer complications and reduced sedation wastage. These findings support the wider implementation of PDS in appropriately selected patients to improve safety and optimize resource utilization.