Guidelines for sedation and anesthesia in GI endoscopy

This document is an update of guidelines for sedation and anesthesia in endoscopy prepared by the Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE). In preparing this guideline, a search of the medical literature was performed by using PubMed from January 1980 through August 2017 that related to the topic of sedation and anesthesia for gastrointestinal endoscopy by using the keyword(s) sedation, anesthesia, gastrointestinal endoscopy, endoscopy, endoscopic procedures, and procedures. The search was supplemented by accessing the related articles feature of PubMed, with articles identified on PubMed as the references. Pertinent studies published in English were reviewed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data existed from well-designed prospective trials, emphasis was given to results from large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines were drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations were based on reviewed studies and were graded on the strength of the supporting evidence by using the GRADE criteria (Table 1).(1) This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from these guidelines.