Sedation for Gastrointestinal Endoscopy—A Case-Based Review

Sedation plays a crucial role in gastrointestinal endoscopy, balancing patient comfort and procedural safety. With the increasing complexity of gastrointestinal endoscopic procedures, comes the inherent risk of sedation-related complications. This review, based on the 2024 British Society of Gastroenterology (BSG) guidelines, outlines updated strategies to address the increasingly diverse clinical needs. This review article focuses on case studies to highlight key recommendations for different patient groups. Case analyses highlight unique sedation considerations for patients with comorbidities such as obstructive sleep apnoea (OSA), cardiac dysrhythmia, and chronic kidney disease, emphasizing the need for thorough pre-procedural assessment and individualized sedation plans. Special considerations for the choice of sedation in pregnant and breastfeeding patients are explored. In emergency endoscopies, particularly for upper gastrointestinal bleeding, close collaboration with anaesthetics is essential to determine sedation choice, airway management, and the ceiling of care. The review also examines the need for deep sedation in complex or combined procedures such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), advocating for resource investment to support safe and effective sedation practices.