Digestive Endoscopy| Volume 49, ISSUE 11, P1185-1190, November 2017

Download started.


Italian Society of Digestive Endoscopy (SIED) position paper on the non-anaesthesiologist administration of propofol for gastrointestinal endoscopy

  • Rita Conigliaro
    Corresponding author at: Gastroenterology and Digestive Endoscopy Unit, Ospedale Civile S. Agostino-Estense, Viale Giardini 1355, 41126 Modena, Italy. Fax: +39 0593961216.
    Gastroenterology and Digestive Endoscopy Unit, Ospedale S. Agostino-Estense Hospital/Hospital-University Institution, Modena, Italy
    Search for articles by this author
  • Lorella Fanti
    Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele, University-Scientific Institute San Raffaele, Milan, Italy
    Search for articles by this author
  • Mauro Manno
    Digestive Endoscopy Unit, Ospedale di Carpi, Ramazzini Hospital, Carpi, Modena, Italy
    Search for articles by this author
  • Piero Brosolo
    Gastroenterology Unit, Ospedale S. Maria degli Angeli Hospital, Pordenone, Italy
    Search for articles by this author
  • Italian Society of Digestive Endoscopy (SIED) Sedation Group
Published:September 04, 2017DOI:


      Propofol sedation by non-anesthesiologists in GI endoscopy, despite generally considered a safe procedure, is still a matter of debate. Benefits of propofol sedation include rapid onset of action, greater patient comfort and fast recovery with prompt discharge from the endoscopy unit.
      The use of propofol for sedation in GI endoscopy, preceded by dedicated training courses, has been approved by several anaesthesiologist and gastroenterologist societies but an Italian position paper taking into account the Italian law is lacking.
      In the present document, the Italian Society of Digestive Endoscopy (SIED) Sedation Group, on behalf of the SIED, presents a series of updated position statements concerning propofol sedation in GI endoscopy. The paper summarizes the advantages of propofol, how it should be administered and how patients should be monitored. Moreover, details concerning proper training of non-anaesthesiologist personnel involved in its use are provided. Protocols concerning propofol use s must be shared with the hospital's anaesthesiology staff and approved by the hospital’s Executive Director.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rex D.K.
        • Deenadayalu V.P.
        • Eid E.
        • Imperiale T.F.
        • Walker J.A.
        • Sandhu K.
        • et al.
        Endoscopist-directed administration of propofol: a worldwide safety experience.
        Gastroenterology. 2009; 137: 1229-1237
        • Dumonceau J.M.
        • Riphaus A.
        • Schreiber F.
        • Vilmann P.
        • Beilenhoff U.
        • Aparicio J.R.
        • et al.
        European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: non-anaesthesiologist administration of propofol for GI endoscopy—update June 2015.
        Endoscopy. 2015; 47: 1175-1189
        • Byrne M.F.
        • Chiba N.
        • Singh H.
        • Sadowski D.C.
        Propofol use for sedation during endoscopy in adults: a Canadian Association of Gastroenterology position statement.
        Can J Gastroenterol. 2008; 22: 457-459
        • Vargo J.J.
        • Cohen L.B.
        • Rex D.K.
        • Kwo P.Y.
        Position statement: nonanesthesiologist administration of propofol for GI endoscopy.
        Gastroenterology. 2009; 137: 2161-2167
        • Vargo J.J.
        • Cohen L.B.
        • Rex D.K.
        • Kwo P.Y.
        Position statement: nonanesthesiologist administration of propofol for GI endoscopy.
        Am J Gastroenterol. 2009; 104: 2886-2892
        • Dumonceau J.M.
        • Riphaus A.
        • Beilenhoff U.
        • Vilmann P.
        • Hornslet P.
        • Aparicio J.R.
        • et al.
        European curriculum for sedation training in gastrointestinal endoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA).
        Endoscopy. 2013; 45: 496-504
        • McQuaid K.R.
        • Laine L.
        A systematic review and meta-analysis of randomised controlled trials of moderate sedation for routine endoscopic procedures.
        Gastrointest Endosc. 2008; 67: 910-923
        • Wang D.
        • Chen C.
        • Chen J.
        • Xu Y.
        • Wang L.
        • Zhu Z.
        • et al.
        The use of propofol as a sedative agent in gastrointestinal endoscopy: a meta-analysis.
        PLoS One. 2013; 8: e53311
        • Qadeer M.A.
        • Vargo J.J.
        • Khandwala F.
        • Lopez R.
        • Zuccaro G.
        Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis.
        Clin Gastroenterol Hepatol. 2005; 3: 1049-1056
        • Wehrmann T.
        • Riphaus A.
        Sedation with propofol for interventional endoscopic procedures: a risk factor analysis.
        Scand J Gastroenterol. 2008; 43: 368-374
        • Sieg A.
        • Beck S.
        • Scholl S.
        • Heil F.J.
        • Gotthardt D.N.
        • Stremmel W.
        • et al.
        Safety analysis of endoscopist-directed Propofol sedation: a prospective, national multicenter study of 24 441 patients in German outpatient practices.
        J Gastroenterol Hepatol. 2014; 29: 517-523
        • Vargo J.J.
        • Niklewski P.J.
        • Williams J.L.
        • Martin J.F.
        • Faigel D.O.
        Patient safety during sedation by anaesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1.38 million procedures.
        Gastrointest Endosc 2016. 2017; 85: 101-108
        • Ferreira A.O.
        • Torres J.
        • Barjas E.
        • Nunes J.
        • Glória L.
        • Ferreira R.
        • et al.
        Non-anaesthesiologist administration of propofol sedation for colonoscopy is safe in low risk patients: results of a non-inferiority randomised controlled trial.
        Endoscopy. 2016; 48: 747-753
        • Slagelse C.
        • Vilmann P.
        • Hornslet P.
        • Hammering A.
        • Mantoni T.
        Nurse-administered propofol sedation for gastrointestinal endoscopic procedures: first Nordic results from implementation of a structured training program.
        Scand J Gastroenterol. 2011; 46: 1503-1509
        • Rivera B.
        The current status of nurse-administered propofol sedation in endoscopy: an evidence-based practice nurse fellowship project.
        Gastroenterol Nurs. 2015; 38: 297-304
        • Jensen J.T.
        • Konge L.
        • Møller A.
        • Hornslet P.
        • Vilmann P.
        Endoscopy nurse administered propofol sedation performance. Development of an assessment tool and a reliability testing model.
        Scand J Gastroenterol. 2014; 49: 1014-1019
        • Kulling D.
        • Orlandi M.
        • Inauen W.
        Propofol sedation during endoscopic procedures: how much staff and monitoring are necessary.
        Gastrointest Endosc. 2007; 66: 443-449
        • Dietrich C.G.
        • Kottmann T.
        • Diedrich A.
        • Drouven F.M.
        Sedation-associated complications in endoscopy are not reduced significantly by implementation of the German S-3-guideline and occur in a severe manner only in patients with ASA class III and higher.
        Scand J Gastroenterol. 2013; 48: 1082-1087
        • Training committee
        • American Society for Gastrointestinal Endoscopy
        Training guideline for use of propofol in gastrointestinal endoscopy.
        Gastrointest Endosc. 2004; 60: 167-172
        • Koshy G.
        • Nair S.
        • Norkus E.P.
        • Hertan H.I.
        • Pitchumoni C.S.
        Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy.
        Am J Gastroenterol. 2000; 95: 1476-1479
        • Al-Awabdy B.W.C.
        Use of anaesthesia on the rise in gastrointestinal endoscopy.
        World J Gastrointest Endosc. 2013; 5: 1-5
        • Dominitz J.A.
        • Baldwin L.M.
        • Green P.
        • Kreuter W.I.
        • Ko C.W.
        Regional variation in anaesthesia assistance during outpatient colonoscopy is not associated with differences in polyp detection or complication rates.
        Gastroenterology. 2013; 144: 298-306
        • Hassan C.
        • Benamouzig R.
        • Spada C.
        • Ponchon T.
        • Zullo A.
        • Saurin J.C.
        • et al.
        Cost effectiveness and projected national impact of colorectal cancer screening in France.
        Endoscopy. 2011; 43: 780-789
        • Riphaus A.
        • Wehrmann T.
        • Weber B.
        • Arnold J.
        • Beilenhoff U.
        • Bitter H.
        • et al.
        Guideline: sedation for gastrointestinal endoscopy 2008.
        Endoscopy. 2009; 4: 787-815
        • Agostoni M.
        • Fanti L.
        • Gemma M.
        • Pasculli N.
        • Beretta L.
        • Testoni P.A.
        • et al.
        Adverse events during monitored anaesthesia care for GI endoscopy: an 8-year experience.
        Gastrointest Endosc. 2011; 74: 266-275
        • Cohen L.B.
        Patient monitoring during gastrointestinal endoscopy: why, when and how?.
        Gastrointest Endosc Clin N Am. 2008; 18: 651-663
        • American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists
        Practice guidelines for sedation and analgesia by non-anesthesiologists.
        Anesthesiology. 2002; 9: 1004-1017
        • ASGE Technology Committee
        • Gottlieb K.T.
        • Banerjee S.
        • Barth B.A.
        • et al.
        Monitoring equipment for endoscopy.
        Gastrointest Endosc. 2013; 77: 175-180
        • Fu E.S.
        • Downs J.B.
        • Schweiger J.W.
        • Miguel R.V.
        • Smith R.A.
        Supplemental oxygen impairs detection of hypoventilation by pulse oximetry.
        Chest. 2004; 126: 1552-1558
        • Chernik D.A.
        • Gillings D.
        • Laine H.
        • Hendler J.
        • Silver J.M.
        • Davidson A.B.
        • et al.
        Validity and reliability of the observer’s assessment of alertness/sedation scale: study with intravenous midazolam.
        J Clin Psychopharmacol. 1990; 10: 244-251
        • Spinelli P.
        • Pacilli P.
        • Sicignano A.
        Clinical use of flumazenil (Ro 15-1788) after endoscopic procedures.
        Endoscopy. 1988; 20: 86
        • Dahan A.
        • Aarts L.
        • Smith T.W.
        Incidence, reversal and prevention of opioid induced respiratory depression.
        Anesthesiology. 2010; 112: 226-238
        • Yusoff I.F.
        Endoscopist administered propofol for upper-GI EUS is safe and effective: a prospective study in 500 patients.
        Gastrointest Endosc. 2004; 60: 358-360
        • Trevisani L.
        • Cifalà V.
        • Gilli G.
        • Matarese V.
        • Zelante A.
        • Sartori S.
        Post-anaesthetic discharge scoring system to assess patient recovery and discharge after colonoscopy.
        World J Gastrointest Endosc. 2013; 16: 502-507
        • Moon S.H.
        Sedation regimens for gastrointestinal endoscopy.
        Clin Endosc. 2014; 47: 135-140
        • Van Natta M.E.
        • Rex D.K.
        Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy.
        Am J Gastroenterol. 2006; 101: 2209-2217
        • Fanti L.
        • Gemma M.
        • Agostoni M.
        • Rossi G.
        • Ruggeri L.
        • Azzolini M.L.
        • et al.
        Target controlled infusion for non-anaesthesiologist propofol sedation during gastrointestinal endoscopy: the first double blind randomised controlled trial.
        Dig Liver Dis. 2015; 47: 566-571
        • Kulling D.
        • Bauerfeind P.
        • Fried M.
        • Biro P.
        Patient-controlled analgesia and sedation in gastrointestinal endoscopy.
        Gastrointest Endosc Clin N Am. 2004; 14: 353-368
        • Cohen L.B.
        • Ladas S.D.
        • Vargo J.J.
        • Paspatis G.A.
        • Bjorkman D.J.
        • Van der Linden P.
        • et al.
        Sedation in digestive endoscopy: the Athens international position statements.
        Aliment Pharmacol Ther. 2010; 32: 425-442
        • Enestvedt B.K.
        • Eisen G.M.
        • Holub J.
        • Lieberman D.A.
        Is the American Society of Anesthesiologists classification useful in risk stratification for endoscopic procedures.
        Gastrointest Endosc. 2013; 77: 464-471
        • Lucendo A.J.
        • González-Huix F.
        • Tenias J.M.
        • López-Rosés L.
        • Alonso-Aguirre P.
        • Quintero E.
        • et al.
        Gastrointestinal endoscopy sedation and monitoring practices in Spain: a nationwide survey in the year 2014.
        Endoscopy. 2015; 47: 383-390
        • Fanti L.
        • Agostoni M.
        • Gemma M.
        • Radaelli F.
        • Conigliaro R.
        • Beretta L.
        • et al.
        Sedation and monitoring for gastrointestinal endoscopy: a nationwide web survey in Italy.
        Dig Liver Dis. 2011; 43: 726-730
        • Dumonceau J.M.
        • Riphaus A.
        • Aparicio J.R.
        • Knape J.T.
        • Ortmann M.
        • Paspatis G.
        • et al.
        European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: non-anesthesiologist administration of propofol for GI endoscopy.
        Endoscopy. 2010; 42: 960-974
        • Pelosi P.
        Retraction of endorsement: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: non-anaesthesiologist administration of propofol for GI endoscopy.
        Endoscopy. 2012; 44: 302
      1. New Italian Professional Ethics Code May 2014—Nuovo Codice Deontologia Medica.pdf.

      2. DECRETO LEGISLATIVO N. 219, 24 APRILE 2006 art 87 (Gazzetta Ufficiale n. 142 del 21.06.06, Suppl. Ordinario n. 153).