A retrospective analysis of the effects of moderate sedation on the degree of cardia exposure in overweight elderly patients.

[BACKGROUND] Gastric cancer is a type of malignant gastrointestinal tumor that poses a serious threat to human life and ranks as the second leading cause of cancer-related mortality worldwide. Although cardia-related diseases are rarely reported in the literature on gastrointestinal disorders, cardia lesions are not uncommon in clinical practice. The development of esophageal cancer may be associated with risk factors for esophageal adenocarcinoma, such as reflux esophagitis, high-fat diet, advanced age, and obesity. During gastroscopy, it is important to note that inadequate visualization of the esophagus may result from various factors, which can affect the diagnosis of esophageal lesions and lead to misdiagnosis or missed diagnoses. Currently, intravenous sedation using a combination of fentanyl and propofol is routinely administered during gastrointestinal endoscopy. The use of propofol in gastroscopy has been shown to improve procedural quality, enhance patient tolerance, and increase the accuracy of endoscopic diagnosis. However, the differences in esophageal exposure between moderate and deep sedation still require further clinical validation.

[METHODS] This study was a single-center retrospective clinical study. One hundred and twenty elderly overweight patients who underwent sedation for upper gastrointestinal endoscopy at our Gastrointestinal Endoscopy Center from May 2020 to August 2023 were retrospectively collected and divided into a moderate sedation group (Group A) and a deep sedation group (Group B) according to the anesthesia method. Primary outcome index: compare the sedation success rate and cardia exposure degree between the two groups. Secondary outcome indicators: compare the incidence of hypoxia during sedation between the two groups. Comparison of sedation recovery time, pain [visual analog scale (VAS)] and patient satisfaction.

[RESULTS] A total of 120 patients aged 60-75 years with body mass index ≧ 25 kg/m were enrolled. The general data of the patients in the two groups were comparable (P > 0.05).The sedation success rate was comparable in Groups A and B (94.83% vs. 96.78%, P = 0.594).The degrees of cardia exposure in group A and group B were compared. The degrees of cardia exposure in Group A with scores of 1, 2, 3, and 4 were 12 cases (20.69%), 13 cases (22.41%), 19 cases (32.76%), and 14 cases (24.14%), respectively. The degrees of cardia exposure in group B were 21 cases (33.87%), 19 cases (30.65%), 18 cases (29.03%), and 4 cases (6.45%), respectively. Compared with group B, group A had a higher degree of cardia exposure, and the difference was statistically significant (p = 0.029). The total perioperative adverse reactions were relatively lower in group A compared with group B, and the difference was statistically significant (P = 0.049).The incidence of hypoxia (2%vs11%) and sedation recovery time (10.08 ± 2.18vs.15.38 ± 3.25) were significantly smaller in group A than in group B, and the differences were statistically significant (P < 0.05).The satisfaction with endoscopy was higher in both groups ( 98.28%vs.96.78%, P = 1.000), the difference was not statistically significant.The exposure of the cardia during gastroscopy was not significantly associated with patient gender, comorbidities such as diabetes, hypertension, or chronic obstructive pulmonary disease(COPD), or gastric or bile reflux, but was significantly associated with the depth of anesthesia (P < 0.05).

[CONCLUSION] Both moderate and deep sedation are applicable for upper gastrointestinal endoscopy in elderly overweight patients. However, moderate sedation is more suitable than deep sedation for those with unstable cardiopulmonary function. Compared with deep sedation, moderate sedation provides better cardia exposure, a lower incidence of hypoxia, faster recovery time, improved safety, and comparable patient satisfaction, making it worthy of clinical promotion.