Role of Capnography for Gastrointestinal Endoscopy
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Abstract
Gastrointestinal endoscopy is one of the most frequently performed diagnostic and therapeutic procedures worldwide. Sedation is routinely administered to improve patient comfort, procedural efficiency, and endoscopist satisfaction. However, sedation can depress central respiratory drive, reduce airway muscle tone, and impair protective reflexes. This predisposes patients to hypoventilation, airway obstruction, and apnea, which can lead to hypoxemia and cardiac complications if not promptly addressed. Capnography, the continuous measurement and graphical display of exhaled carbon dioxide concentration, provides real-time assessment of ventilation. It can reveal ventilatory compromise within seconds, enabling earlier intervention. Over the past two decades, its role in procedural sedation has expanded, supported by clinical evidence, expert consensus, and evolving guideline recommendations.
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References
Amornyotin S. Sedation and monitoring for gastrointestinal endoscopy. World J Gastrointest Endosc. 2013;5:47-55.
Amornyotin S. Sedation-related complications in gastrointestinal endoscopy. World J Gastrointest Endosc. 2013;5:527-33.
Amornyotin S. Monitoring equipment for gastrointestinal endoscopy. Thai J Anesthesiol. 2018;44:143-8.
American Society of Anesthesiologists Committee on Standards and Practice Parameters. Practice guidelines for moderate procedural sedation and analgesia 2018. Anesthesiology. 2018;128:437-79.
Early DS, Lightdale JR, Vargo JJ, et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018;87:327-37.
Hinkelbein J, Lamperti M, Akeson J, et al. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol. 2018;35:6-24.
Sidhu R, Turnbull D, Haboubi H, et al. British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy. Gut. 2024;73:219-45.
Cacho G, Pérez-Calle JL, Barbado A, Lledó JL, Ojea R, Fernández-Rodríguez CM. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy. Rev Esp Enferm Dig. 2010;102:86-9.
Gerstenberger PD. Capnography and patient safety for endoscopy. Clin Gastroenterol Hepatol. 2010;8:423-5.
Teng WN, Ting CK, Wang YT, et al. Oral capnography is more effective than nasal capnography during sedative upper gastrointestinal endoscopy. J Clin Monit Comput. 2018;32:321-6.
Hihih Valbuena I, Sancho A, Alsina E, Brogly N, Gilsanz F. Does capnography improve safety in moderate-deep sedation for gastrointestinal endoscopic procedures provided by anaesthesiologists? A prospective cohort study. J Clin Monit Comput. 2025;39:731-7.
Bondre S, Jain S, Yadav N, Kotak P, Tidke S. Evaluation of effect of end tidal carbondioxide (Etco2) monitoring on patient’s safety during propofol and fentanyl based sedation for short surgical procedures compared to standard monitoring-an observational study. Intern J Pharm Clin Res. 2024;16:499-507.
Jopling MW, Qiu J. Capnography sensor use is associated with reduction of adverse outcomes during gastrointestinal endoscopic procedures with sedation administration. BMC Anesthesiol. 2017;17:157.
Beitz A, Riphaus A, Meining A, et al. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol. 2012;107:1205-12.
Kim SH, Park M, Lee J, Kim E, Choi YS. The addition of capnography to standard monitoring reduces hypoxemic events during gastrointestinal endoscopic sedation: a systematic review and meta-analysis. Ther Clin Risk Manag. 2018;14:1605-14.
Lian Q, Wu J, Zhang J, et al. Capnography monitoring reduces incidence of hypoxia in older patients undergoing gastrointestinal endoscopy under propofol sedation. Endosc Int Open. 2025;13:a26636372.
Kilic ET, Gerenli N. The effects of capnography during sedation in pediatric esophagogastroduodenoscopy procedures: a randomized controlled study. Endosc Gastrointest. 2019;27:31-7.
Prathanvanich P, Chand B. The role of capnography during upper endoscopy in morbidly obese patients: a prospective study. Surg Obesity Related Dis. 2015;11:193-8.
Takimoto Y, Iwasaki E, Horibe M, et al. Capnographic monitoring using a novel mainstream system during endoscopic ultrasound and endoscopic retrograde cholangiopancreatography: a prospective randomized controlled trial. J Hepatobiliary Pancreat Sci. 2025;32:254-63.
