Comparison of Conscious and Deep Sedation Methods in Terms of Pulmonary Complications in ERCP Procedures of Patients with Billroth II Gastrectomy: A Retrospective Study

Abstract Background/Objectives: Patients who have undergone Billroth II gastrectomy may develop gastroparesis, hypomotility, and reflux esophagitis. These patients are at risk of aspiration of gastric contents into the lungs when subsequently sedated for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. The aim of this study was to compare conscious sedation and deep sedation in terms of pulmonary complications in this selected cohort. Methods: Patients who had previously undergone Billroth II surgery and underwent ERCP procedure with sedation for gallstones or biliary tract strictures in a tertiary hospital between January 2020 and September 2023 were studied. Patient records were retrospectively obtained from the hospital information system. All patients were divided into two groups as conscious sedation (Group CS) and deep sedation (Group DS). The groups were compared statistically in terms of pulmonary complications. Results: 63 ERCP procedures were performed on 28 patients who had undergone Billroth II gastrectomy. There were 37 procedures involving conscious sedation (Group CS) and 26 involving deep sedation (Group DS). No statistically significant difference was found regarding pulmonary aspiration (p=0.297) and other respiratory complications as laryngospasm, desaturation between two groups. In Group DS, it was observed that vomiting incidence was higher (p=0.012), and airway maneuver requirements were increased (p=0.007). Conclusions: In patients undergone Billroth II gastrectomy, both conscious sedation and deep sedation techniques can be used effectively during ERCP procedures. Complication rates and patient outcomes of the two techniques are comparable. The occurrence of respiratory complications leading to adverse postprocedural outcomes requires careful monitoring and meticulous follow-up for these patients.