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Anesthesiology129 papers

Gastrointestinal complication of procedure

Last edited: 4/14/2026

Overview

Gastrointestinal complications following endoscopic procedures can include hemodynamic instability, respiratory issues, and allergic reactions, often related to sedative agents like propofol.

Diagnosis

  • Monitor vital signs (blood pressure, oxygen saturation, respiratory rate) pre-, intra-, and post-procedure 323.
  • Assess for signs of allergic reactions, such as urticaria or anaphylaxis 1.
  • Evaluate patient comfort and procedural success through patient feedback and endoscopic visibility 623.

    • Management

  • First-line treatments:
    • - Use of alternative sedatives to propofol, such as remimazolam, which has fewer hemodynamic effects 37. - Combination sedation with agents like alfentanil to reduce propofol dosage and mitigate adverse effects 78.
  • Adjunctive measures:
    • - Premedication with midazolam to enhance sedation efficacy and reduce propofol requirements 2830. - Topical pharyngeal anesthesia (e.g., lidocaine) to improve patient comfort without intravenous sedation 2635.

    Special Populations

  • Pediatrics:
    • - Consider dexmedetomidine or midazolam for sedation, balancing efficacy and safety 2729.
  • Elderly:
    • - Exercise caution with propofol due to increased risk of hypotension and delayed recovery 113.
  • Comorbidities:
    • - Patients with respiratory conditions may benefit from agents that preserve respiratory drive, such as ketamine 4. - Cannabis users may require adjusted sedative dosages and closer monitoring for respiratory and cardiac complications 9.

    Key Recommendations

  • Consider alternative sedatives to propofol, such as remimazolam, to minimize hemodynamic instability (Evidence: Strong 37).
  • Utilize combination sedation regimens (e.g., remimazolam with alfentanil) to reduce propofol exposure and adverse effects (Evidence: Moderate 78).
  • Implement premedication with midazolam to optimize sedation protocols and potentially reduce the dose of intravenous sedatives (Evidence: Moderate 2830).
  • Employ topical anesthesia for pharyngeal discomfort to enhance patient tolerance without relying solely on intravenous sedation (Evidence: Moderate 2635).
  • Tailor sedation approaches based on patient age and comorbidities, favoring agents that preserve respiratory function in high-risk groups (Evidence: Expert opinion).

    • References

    1 Hu L, Cao S, Zhao C, Wu F. Combination of Sufentanil and Topiramate with Propofol for Sedation in Patients Undergoing Gastroscopy and Reducing Allergic Response. Journal of visualized experiments : JoVE 2026. link 2 Parrella A, Rusconi D, Povoli A, Guarini A, Munno N, Petrocelli G et al.. Mapping training programs for endoscopy nurses in gastroenterology: a scoping review. European journal of gastroenterology & hepatology 2025. link 3 Lee K, Jung DH, Lee SJ, Yoo YC, Shin SK. Effect of remimazolam on oxygen reserve compared with propofol during upper gastrointestinal endoscopy: Randomized controlled study. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2025. link 4 Edelson JC, Edelson CV, Rockey DC, Morales AL, Chung KK, Robles MJ et al.. Randomized Controlled Trial of Ketamine and Moderate Sedation for Outpatient Endoscopy in Adults. Military medicine 2024. link 5 Pacheco de Vasconcelos SR, Alcántara Montero A, Fernández Bermejo M. Green discoloration of the urine following sedation with propofol for colonoscopy. Revista espanola de enfermedades digestivas 2023. link 6 Cai MX, Gao Y, Li L, Feng W, Wang YL, Li ZS et al.. Four-Hour Fasting for Semifluids and 2-Hour Fasting for Water Improves the Patient Experience of Esophagogastroduodenoscopy: A Randomized Controlled Trial. Gut and liver 2023. link 7 Shi W, Cheng Y, He H, Fang Q, Hu Y, Xu X et al.. Efficacy and Safety of the Remimazolam-Alfentanil Combination for Sedation During Gastroscopy: A Randomized, Double-blind, Single-center Controlled Trial. Clinical therapeutics 2022. link 8 Xu C, He L, Ren J, Zhou J, Guo H, Chen N et al.. Efficacy and Safety of Remimazolam Besylate Combined with Alfentanil in Painless Gastroscopy: A Randomized, Single-Blind, Parallel Controlled Study. Contrast media & molecular imaging 2022. link 9 King DD, Stewart SA, Collins-Yoder A, Fleckner T, Price LL. Anesthesia for Patients Who Self-Report Cannabis (Marijuana) Use Before Esophagogastroduodenoscopy: A Retrospective Review. AANA journal 2021. link 10 Sasala L, Crippen L, Neft MW. Cost Analysis of Intravenous Propofol Monotherapy versus Intravenous Combination Sedation in Patients Undergoing Outpatient Gastrointestinal Endoscopy. AANA journal 2020. link 11 Kim JH, Kim DH, Kim JH. Low-dose midazolam and propofol use for conscious sedation during diagnostic endoscopy. The Kaohsiung journal of medical sciences 2019. link 12 Kim EH, Park JC, Shin SK, Lee YC, Lee SK. Effect of the midazolam added with propofol-based sedation in esophagogastroduodenoscopy: A randomized trial. Journal of gastroenterology and hepatology 2018. link 13 Stogiannou D, Protopapas A, Protopapas A, Tziomalos K. Is propofol the optimal sedative in gastrointestinal endoscopy?. Acta gastro-enterologica Belgica 2018. link 14 Yoon SW, Choi GJ, Lee OH, Yoon IJ, Kang H, Baek CW et al.. Comparison of propofol monotherapy and propofol combination therapy for sedation during gastrointestinal endoscopy: A systematic review and meta-analysis. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2018. link 15 Sebastián Domingo JJ, Cabrera Chaves T, Simón Marco MÁ. Enough discussions about who should use propofol in gastrointestinal endoscopy. Revista espanola de enfermedades digestivas 2017. link 16 McFadzean WJ, Hall EJ, van Oostrom H. Effect of premedication with butorphanol or methadone on ease of endoscopic duodenal intubation in dogs. Veterinary anaesthesia and analgesia 2017. link 17 Sargin M, Uluer MS, Aydogan E, Hanedan B, Tepe Mİ, Eryılmaz MA et al.. Anxiety Levels in Patients Undergoing Sedation for Elective Upper Gastrointestinal Endoscopy and Colonoscopy. Medical archives (Sarajevo, Bosnia and Herzegovina) 2016. link 18 Sienkiewicz E, Albrecht P, Ziółkowski J, Dziechciarz P. Propofol-alfentanyl versus midazolam-alfentanyl in inducing procedural amnesia of upper gastrointestinal endoscopy in children--blind randomised trial. European journal of pediatrics 2015. link 19 Hsieh YH, Lin HJ, Hsieh JJ, Tseng KC, Tseng CW, Hung TH et al.. Meperidine as the single sedative agent during esophagogastroduodenoscopy, a double-blind, randomized, controlled study. Journal of gastroenterology and hepatology 2013. link 20 Radford PD, Unadkat SN, Rollin M, Tolley NS. Disinfection of flexible fibre-optic endoscopes out-of-hours: confidential telephone survey of ENT units in England - 10 years on. The Journal of laryngology and otology 2013. link 21 Levitzky BE, Lopez R, Dumot JA, Vargo JJ. Moderate sedation for elective upper endoscopy with balanced propofol versus fentanyl and midazolam alone: a randomized clinical trial. Endoscopy 2012. link 22 Reilink R, Stramigioli S, Kappers AM, Misra S. Evaluation of flexible endoscope steering using haptic guidance. The international journal of medical robotics + computer assisted surgery : MRCAS 2011. link 23 Sharma SK, Maharjan DK, Thapa PB, Adhikari SB, Byenjankar B, Khadka S et al.. The role of sedation and pulse oximetry during upper gastrointestinal endoscopy. JNMA; journal of the Nepal Medical Association 2009. link 24 Robertson DJ, Jacobs DP, Mackenzie TA, Oringer JA, Rothstein RI. Clinical trial: a randomized, study comparing meperidine (pethidine) and fentanyl in adult gastrointestinal endoscopy. Alimentary pharmacology & therapeutics 2009. link 25 Mayberry H, Mayberry JF. The role of an information sheet in patient led decision making about sedation and anaesthesia during gastroscopy. International journal of clinical practice 2008. link 26 Ayoub C, Skoury A, Abdul-Baki H, Nasr V, Soweid A. Lidocaine lollipop as single-agent anesthesia in upper GI endoscopy. Gastrointestinal endoscopy 2007. link 27 Demiraran Y, Korkut E, Tamer A, Yorulmaz I, Kocaman B, Sezen G et al.. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Canadian journal of gastroenterology = Journal canadien de gastroenterologie 2007. link 28 Paspatis GA, Charoniti I, Manolaraki M, Vardas E, Papanikolaou N, Anastasiadou A et al.. Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: a prospective, randomized study. Journal of pediatric gastroenterology and nutrition 2006. link 29 Disma N, Astuto M, Rizzo G, Rosano G, Naso P, Aprile G et al.. Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children. European journal of anaesthesiology 2005. link 30 Mui LM, Teoh AY, Ng EK, Lee YT, Au Yeung AC, Chan YL et al.. Premedication with orally administered midazolam in adults undergoing diagnostic upper endoscopy: a double-blind placebo-controlled randomized trial. Gastrointestinal endoscopy 2005. link02590-8) 31 Binek J, Sagmeister M, Borovicka J, Knierim M, Magdeburg B, Meyenberger C. Perception of gastrointestinal endoscopy by patients and examiners with and without background music. Digestion 2003. link 32 Ishiguro T, Ishiguro C, Ishiguro G, Nagawa H. Midazolam sedation for upper gastrointestinal endoscopy: comparison between the states of patients in partial and complete amnesia. Hepato-gastroenterology 2002. link 33 Koshy G, Nair S, Norkus EP, Hertan HI, Pitchumoni CS. Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy. The American journal of gastroenterology 2000. link 34 Stermer E, Levy N, Beny A, Meisels R, Tamir A. Ambience in the endoscopy room has little effect on patients. Journal of clinical gastroenterology 1998. link 35 Dhir V, Swaroop VS, Vazifdar KF, Wagle SD. Topical pharyngeal anesthesia without intravenous sedation during upper gastrointestinal endoscopy. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 1997. link 36 Tan CC, Freeman JG. Throat spray for upper gastrointestinal endoscopy is quite acceptable to patients. Endoscopy 1996. link 37 Barthel JS, Marshall JB, King PD, Afridi SA, Gibb LG, Madsen R. The effect of droperidol on objective markers of patient cooperation and vital signs during esophagogastroduodenoscopy: a randomized, double-blind, placebo-controlled, prospective investigation. Gastrointestinal endoscopy 1995. link70242-3) 38 Froehlich F, Schwizer W, Thorens J, Köhler M, Gonvers JJ, Fried M. Conscious sedation for gastroscopy: patient tolerance and cardiorespiratory parameters. Gastroenterology 1995. link90441-7) 39 Bahal-O'Mara N, Nahata MC, Murray RD, Linscheid TR, Fishbein M, Heitlinger LA et al.. Sedation with meperidine and midazolam in pediatric patients undergoing endoscopy. European journal of clinical pharmacology 1994. link 40 Hedenbro JL, Ekelund M, Aberg T, Lindblom A. Oral sedation for diagnostic upper endoscopy. Endoscopy 1991. link

    Original source

    1. [1]
      Combination of Sufentanil and Topiramate with Propofol for Sedation in Patients Undergoing Gastroscopy and Reducing Allergic Response. — Hu L, Cao S, Zhao C, Wu F Journal of visualized experiments : JoVE (2026)
    2. [2]
      Mapping training programs for endoscopy nurses in gastroenterology: a scoping review. — Parrella A, Rusconi D, Povoli A, Guarini A, Munno N, Petrocelli G et al. European journal of gastroenterology & hepatology (2025)
    3. [3]
      Effect of remimazolam on oxygen reserve compared with propofol during upper gastrointestinal endoscopy: Randomized controlled study. — Lee K, Jung DH, Lee SJ, Yoo YC, Shin SK Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (2025)
    4. [4]
      Randomized Controlled Trial of Ketamine and Moderate Sedation for Outpatient Endoscopy in Adults. — Edelson JC, Edelson CV, Rockey DC, Morales AL, Chung KK, Robles MJ et al. Military medicine (2024)
    5. [5]
      Green discoloration of the urine following sedation with propofol for colonoscopy. — Pacheco de Vasconcelos SR, Alcántara Montero A, Fernández Bermejo M Revista espanola de enfermedades digestivas (2023)
    6. [6]
      Four-Hour Fasting for Semifluids and 2-Hour Fasting for Water Improves the Patient Experience of Esophagogastroduodenoscopy: A Randomized Controlled Trial. — Cai MX, Gao Y, Li L, Feng W, Wang YL, Li ZS et al. Gut and liver (2023)
    7. [7]
      Efficacy and Safety of the Remimazolam-Alfentanil Combination for Sedation During Gastroscopy: A Randomized, Double-blind, Single-center Controlled Trial. — Shi W, Cheng Y, He H, Fang Q, Hu Y, Xu X et al. Clinical therapeutics (2022)
    8. [8]
      Efficacy and Safety of Remimazolam Besylate Combined with Alfentanil in Painless Gastroscopy: A Randomized, Single-Blind, Parallel Controlled Study. — Xu C, He L, Ren J, Zhou J, Guo H, Chen N et al. Contrast media & molecular imaging (2022)
    9. [9]
      Anesthesia for Patients Who Self-Report Cannabis (Marijuana) Use Before Esophagogastroduodenoscopy: A Retrospective Review. — King DD, Stewart SA, Collins-Yoder A, Fleckner T, Price LL AANA journal (2021)
    10. [10]
      Cost Analysis of Intravenous Propofol Monotherapy versus Intravenous Combination Sedation in Patients Undergoing Outpatient Gastrointestinal Endoscopy. — Sasala L, Crippen L, Neft MW AANA journal (2020)
    11. [11]
      Low-dose midazolam and propofol use for conscious sedation during diagnostic endoscopy. — Kim JH, Kim DH, Kim JH The Kaohsiung journal of medical sciences (2019)
    12. [12]
      Effect of the midazolam added with propofol-based sedation in esophagogastroduodenoscopy: A randomized trial. — Kim EH, Park JC, Shin SK, Lee YC, Lee SK Journal of gastroenterology and hepatology (2018)
    13. [13]
      Is propofol the optimal sedative in gastrointestinal endoscopy? — Stogiannou D, Protopapas A, Protopapas A, Tziomalos K Acta gastro-enterologica Belgica (2018)
    14. [14]
      Comparison of propofol monotherapy and propofol combination therapy for sedation during gastrointestinal endoscopy: A systematic review and meta-analysis. — Yoon SW, Choi GJ, Lee OH, Yoon IJ, Kang H, Baek CW et al. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (2018)
    15. [15]
      Enough discussions about who should use propofol in gastrointestinal endoscopy. — Sebastián Domingo JJ, Cabrera Chaves T, Simón Marco MÁ Revista espanola de enfermedades digestivas (2017)
    16. [16]
      Effect of premedication with butorphanol or methadone on ease of endoscopic duodenal intubation in dogs. — McFadzean WJ, Hall EJ, van Oostrom H Veterinary anaesthesia and analgesia (2017)
    17. [17]
      Anxiety Levels in Patients Undergoing Sedation for Elective Upper Gastrointestinal Endoscopy and Colonoscopy. — Sargin M, Uluer MS, Aydogan E, Hanedan B, Tepe Mİ, Eryılmaz MA et al. Medical archives (Sarajevo, Bosnia and Herzegovina) (2016)
    18. [18]
      Propofol-alfentanyl versus midazolam-alfentanyl in inducing procedural amnesia of upper gastrointestinal endoscopy in children--blind randomised trial. — Sienkiewicz E, Albrecht P, Ziółkowski J, Dziechciarz P European journal of pediatrics (2015)
    19. [19]
      Meperidine as the single sedative agent during esophagogastroduodenoscopy, a double-blind, randomized, controlled study. — Hsieh YH, Lin HJ, Hsieh JJ, Tseng KC, Tseng CW, Hung TH et al. Journal of gastroenterology and hepatology (2013)
    20. [20]
      Disinfection of flexible fibre-optic endoscopes out-of-hours: confidential telephone survey of ENT units in England - 10 years on. — Radford PD, Unadkat SN, Rollin M, Tolley NS The Journal of laryngology and otology (2013)
    21. [21]
      Moderate sedation for elective upper endoscopy with balanced propofol versus fentanyl and midazolam alone: a randomized clinical trial. — Levitzky BE, Lopez R, Dumot JA, Vargo JJ Endoscopy (2012)
    22. [22]
      Evaluation of flexible endoscope steering using haptic guidance. — Reilink R, Stramigioli S, Kappers AM, Misra S The international journal of medical robotics + computer assisted surgery : MRCAS (2011)
    23. [23]
      The role of sedation and pulse oximetry during upper gastrointestinal endoscopy. — Sharma SK, Maharjan DK, Thapa PB, Adhikari SB, Byenjankar B, Khadka S et al. JNMA; journal of the Nepal Medical Association (2009)
    24. [24]
      Clinical trial: a randomized, study comparing meperidine (pethidine) and fentanyl in adult gastrointestinal endoscopy. — Robertson DJ, Jacobs DP, Mackenzie TA, Oringer JA, Rothstein RI Alimentary pharmacology & therapeutics (2009)
    25. [25]
      The role of an information sheet in patient led decision making about sedation and anaesthesia during gastroscopy. — Mayberry H, Mayberry JF International journal of clinical practice (2008)
    26. [26]
      Lidocaine lollipop as single-agent anesthesia in upper GI endoscopy. — Ayoub C, Skoury A, Abdul-Baki H, Nasr V, Soweid A Gastrointestinal endoscopy (2007)
    27. [27]
      The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. — Demiraran Y, Korkut E, Tamer A, Yorulmaz I, Kocaman B, Sezen G et al. Canadian journal of gastroenterology = Journal canadien de gastroenterologie (2007)
    28. [28]
      Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: a prospective, randomized study. — Paspatis GA, Charoniti I, Manolaraki M, Vardas E, Papanikolaou N, Anastasiadou A et al. Journal of pediatric gastroenterology and nutrition (2006)
    29. [29]
      Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children. — Disma N, Astuto M, Rizzo G, Rosano G, Naso P, Aprile G et al. European journal of anaesthesiology (2005)
    30. [30]
      Premedication with orally administered midazolam in adults undergoing diagnostic upper endoscopy: a double-blind placebo-controlled randomized trial. — Mui LM, Teoh AY, Ng EK, Lee YT, Au Yeung AC, Chan YL et al. Gastrointestinal endoscopy (2005)
    31. [31]
      Perception of gastrointestinal endoscopy by patients and examiners with and without background music. — Binek J, Sagmeister M, Borovicka J, Knierim M, Magdeburg B, Meyenberger C Digestion (2003)
    32. [32]
      Midazolam sedation for upper gastrointestinal endoscopy: comparison between the states of patients in partial and complete amnesia. — Ishiguro T, Ishiguro C, Ishiguro G, Nagawa H Hepato-gastroenterology (2002)
    33. [33]
      Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy. — Koshy G, Nair S, Norkus EP, Hertan HI, Pitchumoni CS The American journal of gastroenterology (2000)
    34. [34]
      Ambience in the endoscopy room has little effect on patients. — Stermer E, Levy N, Beny A, Meisels R, Tamir A Journal of clinical gastroenterology (1998)
    35. [35]
      Topical pharyngeal anesthesia without intravenous sedation during upper gastrointestinal endoscopy. — Dhir V, Swaroop VS, Vazifdar KF, Wagle SD Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology (1997)
    36. [36]
      Throat spray for upper gastrointestinal endoscopy is quite acceptable to patients. — Tan CC, Freeman JG Endoscopy (1996)
    37. [37]
      The effect of droperidol on objective markers of patient cooperation and vital signs during esophagogastroduodenoscopy: a randomized, double-blind, placebo-controlled, prospective investigation. — Barthel JS, Marshall JB, King PD, Afridi SA, Gibb LG, Madsen R Gastrointestinal endoscopy (1995)
    38. [38]
      Conscious sedation for gastroscopy: patient tolerance and cardiorespiratory parameters. — Froehlich F, Schwizer W, Thorens J, Köhler M, Gonvers JJ, Fried M Gastroenterology (1995)
    39. [39]
      Sedation with meperidine and midazolam in pediatric patients undergoing endoscopy. — Bahal-O'Mara N, Nahata MC, Murray RD, Linscheid TR, Fishbein M, Heitlinger LA et al. European journal of clinical pharmacology (1994)
    40. [40]
      Oral sedation for diagnostic upper endoscopy. — Hedenbro JL, Ekelund M, Aberg T, Lindblom A Endoscopy (1991)
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