Optimal Sequences of the Same-visit Bidirectional Endoscopy: A Systematic Review and Meta-analysis.

OBJECTIVES: Same-visit colonoscopy and esophagogastroduodenoscopy (EGD) have become common. Recent studies showed conflicting results regarding the performance, safety, and efficacy of different sequences. We conducted this meta-analysis to determine the most favorable performance and discomfort between an EGD followed by colonoscopy (E-C) and colonoscopy followed by EGD (C-E).

METHODS: The authors searched the databases of MEDLINE and EMBASE. The outcomes of interest were the performance (including cecal intubation time, adenoma detection rate, and polyp detection rate), discomfort score (patients and endoscopists; Likert scale), and sedation uses. Pooled mean differences (MD) or odds ratios (OR) were calculated with 95% confidence intervals (CI).

RESULTS: Six randomized controlled trials were included in the meta-analysis. The authors found that there was significantly lower sedative use including, fentanyl (-14.70;95%Cl: 8.20 to 21.20) and propofol (15.58;95%Cl: 3.27 to 27.89) in E-C group compared with C-E group. There was a significantly better discomfort score in patients and endoscopists after both procedures in E-C group than the C-E group with pooled MDs of 0.64 points (95%Cl: 0.09 to 1.20) and 0.47 (95%Cl: 0.05 to 0.90). There are no differences of cecal intubation time, adenoma detection rate, or polyp detection rate between both groups.

CONCLUSION: This study found that the discomfort score was better in the E-C group. However, there was no difference in polyp and adenoma detection. Therefore, the E-C group is the optimal sequence. This article is protected by copyright. All rights reserved.