Respiratory complications during sedation for advanced endoscopic procedures: Impact of obesity
Sedation during advanced endoscopic procedures is associated with an increased risk of respiratory complications, particularly in obese patients. This study aimed to compare respiratory complications between obese and non-obese patients undergoing advanced endoscopic procedures under sedation and to identify independent predictors of these complications. In this retrospective, single-center cohort study, a total of 104 patients who underwent EUS and/or ERCP under sedation were included. Patients were categorized as obese (BMI ≥30 kg/m², n=52) and non-obese (BMI <30 kg/m², n=52). The primary outcome was hypoxemia (SpO₂ <90%). Secondary outcomes included apnea, airway intervention, and other periprocedural complications. Multivariable logistic regression analysis was performed to identify independent predictors of respiratory complications. Hypoxemia was observed more frequently in obese patients compared to non-obese patients (30.8% vs 15.4%, p=0.048). The lowest recorded SpO₂ values were lower in the obese group (90.8 ± 5.1 vs 93.4 ± 4.2, p=0.006). Airway intervention was required more frequently in obese patients (25.0% vs 11.5%, p=0.048). In multivariable analysis, obesity (OR: 2.18, 95% CI: 1.02-4.66, p=0.044), age, ASA class, and procedure duration were identified as independent predictors of respiratory complications. Sedation strategy was not significantly associated with the outcome. Obesity was identified as an independent risk factor for respiratory complications during advanced endoscopic procedures under sedation. These findings highlight the importance of individualized sedation planning and close respiratory monitoring in obese patients.