***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background / Aims : Same-day bidirectional endoscopy ( BDE ) is a commonly performed procedure , but the optimal sequence of the procedure with carbon dioxide insufflation is not well established . In this study , we investigated the optimal sequence for same-day BDE without polypectomy under moderate sedation and carbon dioxide insufflation in terms of sedation doses and colonoscopy performance . Patients and Methods : We performed a prospect i ve observational study of 63 asymptomatic patients who were admitted for physical check-ups . A colonoscopy-esophagogastroduodenoscopy ( EGD ) examination was performed first and then an EGD-colonoscopy examination was performed within 1.5 years . Results : The total procedure time , procedure complexity , bowel preparation quality , cecal intubation time , colon polyp detection rate , and adverse events were similar between the two study groups . The total doses of fentanyl and midazolam were significantly higher for the colonoscopy-EGD group than that for the EGD-colonoscopy group ( 70.8 ± 9.6 μg vs. 56.6 ± 9.2 μg and 6.1 ± 1.3 mg vs. 4.6 ± 1.1 mg , P < 0.0001 and P < 0.0001 , respectively ) . The recovery time to discharge was significantly longer for the colonoscopy-EGD group compared to the EGD-colonoscopy group ( 38.5 ± 3.9 min vs. 31.9 ± 3.2 min , P < 0.001 , respectively ) . Conclusions : EGD-colonoscopy is the optimal sequence for same-day BDE . In this order , the procedures are better tolerated , the sedation doses are reduced , and the recovery time is shorter BACKGROUND AND AIM Same-day bidirectional endoscopy ( BDE ) is a commonly performed procedure , but the optimal sequence for the procedure with moderate conscious sedation is not well established . This study investigated the optimal sequence for same-day BDE under moderate conscious sedation and carbon dioxide insufflation in terms of sedation doses , patient discomfort , and colonoscopy performance . METHODS A prospect i ve r and omized controlled study of 120 patients who were scheduled for BDE examination was performed . Colonoscopy followed by esophagogastroduodenoscopy ( EGD ) examination was performed in 60 patients ( colonoscopy-EGD group ) , and EGD followed by colonoscopy examination was performed in another 60 patients ( EGD-colonoscopy group ) . Endoscopists and patients completed a question naire to assess objective and subjective discomfort . RESULTS Baseline demographics , procedure indications , bowel preparation quality , cecal intubation rate/time , colonoscopy withdrawal time , endoscopic interventions , BDE procedure time , colon polyp/adenoma detection rates , patient discomfort , and adverse events were similar between the two study groups . The total doses of fentanyl and midazolam were significantly higher for the colonoscopy-EGD group than for the EGD-colonoscopy group ( 83.4 ± 17.7 vs 68.7 ± 18.6 μg and 6.3 ± 1.4 vs 5.2 ± 1.3 mg , P < 0.0001 and P < 0.0001 , respectively ) . The recovery time to discharge was significantly longer for the colonoscopy-EGD group than for the EGD-colonoscopy group ( 43.5 ± 16.2 vs 34.5 ± 8.9 min , P = 0.0003 ) . CONCLUSIONS Esophagogastroduodenoscopy followed by colonoscopy is the optimal sequence for same-day BDE under moderate conscious sedation and carbon dioxide insufflation . Following this order allows for a reduction of sedation doses and for shorter recovery times BACKGROUND AND AIM To compare the efficacy and safety of esophagogastroduodenoscopy (EGD)-colonoscopy and colonoscopy-EGD sequences for patients subjected to same-day bidirectional endoscopy under remifentanil and propofol sedation . METHODS A total of 209 eligible out patients scheduled for diagnostic same-day bidirectional endoscopy between 16 February 2016 and 30 April 2016 were r and omly assigned to the EGD-colonoscopy ( n = 106 ) and colonoscopy-EGD ( n = 103 ) sequence groups . Primary endpoint was total dose of propofol required for the procedure . Secondary endpoints included duration of endoscopy , patient satisfaction , adverse effects , endoscopy findings , and cardiopulmonary responses of the patients . RESULTS Patients in the two groups were similar in terms of demographic and clinical data ( P > 0.05 ) . EGD-colonoscopy sequence group had lesser requirement of propofol for sedation ( P < 0.05 ) , faster recovery ( P < 0.001 ) , and lesser influence on mean arterial pressure ( MAP ) during the endoscopy ( P < 0.05 ) . Duration of EGD and colonoscopy , patient satisfaction , adverse effects , and pathological findings did not differ between the two groups . CONCLUSIONS The EGD-colonoscopy sequence may be considered the preferred sequence for same-day bidirectional endoscopy as a result of less cardiovascular stress , lessened need for sedation with propofol , and faster recovery BACKGROUND Suitable propofol plasma concentrations during gastroscopy have not been determined for suppressing somatic and hemodynamic responses in different age groups . METHODS Propofol sedation at target plasma concentrations from 0.5 to 4.0 microgram/ml were performed r and omly in three groups of patients ( 23 per group ) who were undergoing elective outpatient gastroscopy : ages 17 - 49 yr ( group 1 ) , 50 - 69 yr ( group 2 ) , and 70 - 89 yr ( group 3 ) . Plasma propofol concentration in which 50 % of patients do not respond to these different stimuli were determined by logistic regression : verbal comm and ( Cp50ls ) , somatic response to gastroscopy ( Cp50endo ) , and gag response to gastroscopy ( Cp50gag ) . Hemodynamic responses were also investigated in the different age groups . RESULTS Cp50ls concentrations were 2.23 microgram/ml ( group 1 ) , 1.75 microgram/ml ( group 2 ) , and 1.40 microgram/ml ( group 3 ) . The Cp50endo values in groups 1 and 2 were 2.87 and 2.34 microgram/ml , respectively , which were significantly higher than their respective Cp50ls values . Cp50endo value in group 3 was 1.64 microgram/ml , which was close to its Cp50ls value . Because of a high degree of interpatient variability , Cp50gag could not be defined . Systolic blood pressure response decreased with increasing propofol concentrations . CONCLUSIONS The authors determined the propofol concentration necessary for gastroscopy and showed that increasing age reduces it . Propofol concentration that suppresses somatic response induces loss of consciousness in almost all young patients BACKGROUND AND STUDY AIMS Same-day bidirectional endoscopy including esophagogastroduodenoscopy ( EGD ) and colonoscopy is routinely performed to evaluate anemia and gastrointestinal  bleeding , as well as to conduct cancer surveillance . Numerous questions have been raised regarding the most appropriate procedural sequence and the result ing potential procedure interactions . We compared the quality and feasibility of performing EGD and colonoscopy without sedation in patients subjected to EGD-colonoscopy ( Group I ) or colonoscopy-EGD ( Group II ) sequences . PATIENTS AND METHODS A total of 80 patients were prospect ively r and omized into two groups ( 40:40 ) . All EGD examinations were recorded on videotape , and the quality of 18 EGD steps was assessed by three endoscopists . In addition , we analyzed the colonoscopic parameters and subjective discomfort scores of patients . RESULTS Group I displayed significantly superior quality for retroflexion-related steps ( P11 - 13 ; all median of Group I vs Group II = 2:3 ; P < 0.01 ) , visualization of the angular fold ( P10 ; Group I vs Group II = 2:3 ; P = 0.048 ) , and general assessment of the stomach ( P17 ; Group I vs Group II = 2:3 ; P = 0.008 ) and upper GI tract ( P15 ; Group I vs Group II = 2:3 ; P = 0.047 ) . Colonoscopic insertion time , total time , and prolonged insertion ratio did not differ between the two groups . Question naire responses indicated that EGD was perceived to be more stressful in Group II sequence . CONCLUSIONS The quality of EGD steps is influenced by the sequence of bidirectional endoscopy . EGD is perceived to be more stressful to patients when preceded by colonoscopy . Therefore , EGD followed by colonoscopy may be the preferable procedural sequence for same-day bidirectional endoscopy OBJECTIVES To determine the incremental cost-effectiveness of using propofol versus midazolam for  procedural sedation ( PS ) in adults in the emergency department ( ED ) . METHODS The authors conducted a cost-effectiveness analysis from the perspective of the health care provider . The primary outcome was the incremental cost ( or savings ) to achieve one additional successful sedation with propofol compared to midazolam . A decision model was developed in which the clinical effectiveness and cost of a PS strategy using either agent was estimated . The authors derived estimates of clinical effectiveness and risk of adverse events ( AEs ) from a systematic review . The cost of each clinical outcome was determined by incorporating the baseline cost of the ED visit , the cost of the drug , the cost of labor of physicians and nurses , the cost and probability of an AE , and the cost and probability of a PS failure . A st and ard meta-analytic technique was used to calculate the weighted mean difference in recovery times and obtain mean drug doses from patient-level data from a r and omized controlled trial . Probabilistic sensitivity analyses were conducted to examine the uncertainty around the estimated incremental cost-effectiveness ratio using Monte Carlo simulation . RESULTS Choosing a sedation strategy with propofol result ed in average savings of $ 17.33 ( 95 % confidence interval [ CI ] = $ 24.13 to $ 10.44 ) per sedation performed . This result ed in an incremental cost-effectiveness ratio of -$597.03 ( 95 % credibility interval -$6,434.03 to $ 6,113.57 ) indicating savings of $ 597.03 per additional successful sedation performed with propofol . This result was driven by shorter recovery times and was robust to all sensitivity analyses performed . CONCLUSIONS These results indicate that using propofol for PS in the ED is a cost-saving strategy BACKGROUND AND AIM Same-day bidirectional endoscopy , including esophagogastroduodenoscopy ( EGD ) and colonoscopy , is frequently performed to screen for cancer and gastrointestinal bleeding . However , the optimal sequence for the procedures is unclear thus far . The aim of this study was to evaluate the optimal sequence for same-day bidirectional endoscopy . METHODS Consecutive patients undergoing same-day bidirectional endoscopy under propofol sedation were r and omized to either the colonoscopy-first group  ( colonoscopy followed by EGD , n = 87 ) or the  EGD-first group  ( EGD followed by colonoscopy , n = 89 ) . We evaluated the  propofol dose , procedure duration , patient tolerance and recovery , adverse events , and endoscopic findings . The patient tolerance was assessed with a 0 - 10 visual analog scale . RESULTS Total procedure times , patients ' tolerance and recovery , adverse events , and endoscopic findings were similar between the two groups . The total propofol dose was significantly higher for the colonoscopy-first group than for the EGD-first group ( mean 95 % credibility limit : 135.7 [ 70 - 201.4 ] mg vs 124.7 [ 64.1 - 185.3 ] mg , respectively , P = 0.024 ) . Patients in the colonoscopy-first group moved significantly more during colonoscopy than those in the EGD-first group : 1.1 ( 0 - 3.8 ) versus 0.6 ( 0 - 2.9 ) scores , respectively ( P = 0.024 ) . CONCLUSION The optimal sequence for same-day bidirectional endoscopy is EGD followed by colonoscopy . In this order , the procedure is better tolerated , and patients require a lower overall dose of propofol Background Same-day bidirectional endoscopy is commonly performed in clinical practice . However , the optimal sequence of procedures for same-day bidirectional endoscopy has not been established . The purpose of this study was to compare colonoscopy performance and quality between patients who underwent colonoscopy before or after esophagogastroduodenoscopy ( EGD ) .  Methods A total of 1,103 patients were prospect ively r and omized into either the EGD – colonoscopy or colonoscopy – EGD sequence groups . Three patients who had incomplete cecal intubation due to structural obstruction were excluded from the analysis . During colonoscopy , colonoscopic parameters including difficult cecal intubation ( cecal intubation failure and prolonged insertion ) , insertion time , and adenoma detection rate were measured . Out of 1,100 patients , 524 patients without sedation completed a question naire design ed to assess subjective discomfort experienced . Results The colonoscopy completion rate was 99.5 % , and the rate of difficult cecal intub 
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There was no significant difference in the incidences of desaturation , hypotension , hypertension , bradycardia , and tachycardia between the two sequences .
Conclusions When conducting same-day bidirectional endoscopy , EGD followed by colonoscopy is the most beneficial sequence to be used because patients require lower sedative doses , recover faster , and report lesser discomfort