消化器内視鏡診療における鎮静の現状～専門医へのアンケート調査～

Currently, only a few drugs are approved for insurance coverage for sedation during endoscopy, and off-label drug use is commonly practiced due to a lack of public knowledge. To evaluate the current status of endoscopic sedation, we conducted a questionnaire-based survey of 270 medical institutions in the Hokuriku area where board-certified fellows of the Japan Gastroenterological Endoscopy Society work. We obtained questionnaire responses from 160 institutions, including 73 hospitals and 87 clinics. Sedation was found to be performed in 38.6% of 307,628 esophagogastroduodenoscopies and 25.4% of 86,034 colonoscopies at all institutions. The median percentage of sedation frequency at each institution was 25.0% (range, 0-98.1%) for esophagogastroduodenoscopies and 2.1% (range, 0-100%) for colonoscopies. Diazepam was the most commonly used sedative at each institution, accounting for 64.1% of esophagogastroduodenoscopies and 52.5% of colonoscopies, followed by midazolam, which accounted for 31.7% of esophagogastroduodenoscopies and 43.6% of colonoscopies. Propofol was used in 16.3% of institutions in one year, with 4,170 patients receiving it overall. Dexmedetomidine hydrochloride was used in 6.9% of institutions in one year, with 393 patients receiving it overall. In the past five years, serious adverse events such as six cases of respiratory arrest and one case of cerebral infarction have been reported. However, no deaths have been reported. Many endoscopists expressed the opinion (in free answers) that insurance coverage for sedation should be provided at the earliest. In conclusion, we assessed and reported the current status of sedation use in endoscopy. Although a few serious adverse events were reported, endoscopy under sedation was generally performed safely at most institutions.