Sequence of same-day upper and lower gastrointestinal endoscopy does not affect total procedure' time or medication use: A randomized trial.

Background And Aim: Same-day double upper and lower gastrointestinal endoscopy is frequently performed due to overlapping indications. However, it is unclear whether an upper-lower (U-L) or lower-upper (L-U) sequence is optimal. We analyzed the effect of sequence on total procedure time and sedation use.

Methods: A total of 100 patients scheduled for same-day double endoscopy were randomized to the U-L or L-U sequence arm. Primary outcomes, mean total procedure time, and sedative dosages were compared using a -test. We also explored associations of the primary outcomes with patient-related and procedure-related factors.

Results: Comparing U-L and L-U sequences, mean total procedure time was 41.9 (16.2) 43.0 (14.5) min ( = 0.73), diphenhydramine dose 5.5 (15.4) 4.5 (14.0) mg ( = 0.74), fentanyl dose 71.5 (119.3) 77.6 (164.02) μg ( = 0.83), midazolam dose 1.6 (2.5) 1.4 (2.7) mg ( = 0.69), and propofol dose 437.4 (351.4) 444.5 (256.0) mg ( = 0.91), respectively. Total procedure and upper endoscopy times were significantly longer with trainee presence ( = 0.0002) and shorter with conscious sedation ( = 0.003). Upper endoscopy time was longer with higher body mass index ( = 0.001), and lower endoscopy time was longer in patients with cirrhosis or chronic kidney disease ( = 0.002 and 0.009, respectively). Time between procedures was significantly longer in the L-U sequence (7.4 [2.9] 5.3 [1.1] min, [ < 0.001]). The study had 80% power to detect an 8 min difference in total procedure time.

Conclusions: The sequence of same-day double gastrointestinal endoscopy does not affect total procedure time or medication use. Longer total procedure and upper endoscopy times were associated with trainee presence and use of conscious sedation.