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June 27, 2012

Anesthesia Care for Low-Risk Patients Undergoing Gastrointestinal Endoscopies

Author Affiliations

Author Affiliation: Concord Hospital, Sydney, Australia (jamesrnielsen@gmail.com).

JAMA. 2012;307(24):2585-2587. doi:10.1001/jama.2012.6533

To the Editor: Dr Liu and colleagues1 demonstrated wide variation in the use of specialist anesthesia staff to provide sedation for endoscopy. They also estimated that 65% to 85% of endoscopy patients are low risk and inferred that “a substantial share of the spending for gastroenterology anesthesia may be considered potentially discretionary.”

However, important detail necessary to study that hypothesis is missing from their data. First, there is no comparison of safety or complications between the 2 patient cohorts. Second, there is no comparison of patient comfort or satisfaction. Third, there is no information about the relative efficiency of the 2 procedure cohorts (measured both by time taken for procedures and by capacity to visualize the entire bowel and detect and treat disease found). The authors have described variation in sedation practice but not equivalence of quality of practice. Endoscopist-supervised sedation may happen frequently but that does not make it equivalent.