The safety and efficacy of a policy of sedation versus no sedation in the performance of upper gastrointestinal endoscopy : a randomized controlled trial
Bibliographic record
Abstract
Esophagogastroduodenal endoscopy (EGDE) is the most commonly performed endoscopic procedure in Canada and represents 51--65% of all gastrointestinal procedures performed in teaching hospitals. The routine use of conscious sedation during EGDE has facilitated its diffusion, ensured patient and physician satisfaction and has increased the potential risk of cardiorespiratory morbidity. It remains unclear if all adult ambulatory patients require routine conscious sedation prior to diagnostic EGDE, as the efficacy and safety of such a policy has not been rigorously studied in a North American population. Patients were randomly assigned to sedation or placebo in a double-blind trial. So far 360 patients of the anticipated patients have been enrolled, (182 randomized to sedation, 178 randomized to placebo). Groups were similar for all baseline characteristics. Eighty-one percent of patients randomized to placebo were able to complete EGDE without sedation. The major determinant of "successful endoscopy" was the use of sedation (OR = 7.52; 95% CI: 4.61--12.26). Preliminary subgroup analysis suggested that among patients greater than 55 yrs and with decreased pharyngeal sensitivity, there was a greater likelihood of successful unsedated endoscopy, when compared to other subsets (45% successful vs. 39% successful among the unstratified placebo population; 98% power). The use of sedation does not improve technical adequacy. However, the use of sedation in the performance of EGDE is the strongest predictor of a successful endoscopy, patient self-reported satisfaction and willingness to repeat the procedure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.011 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".