From the Guidelines
For patients undergoing an EGD (upper endoscopy) and colonoscopy with propofol sedation, you should stop drinking water at least 2 hours before the procedure. This recommendation is based on the most recent and highest quality evidence available, which suggests that clear liquids, including water, can be consumed up until 2 hours prior to the procedure without increasing the risk of aspiration 1. The 2-hour window allows sufficient time for any consumed water to empty from the stomach, minimizing the risk of aspiration, which is a significant concern when using propofol sedation due to its potent effects on protective reflexes.
Key Considerations
- Solid foods should be avoided for 6-8 hours before the procedure, as recommended by guidelines on preoperative fasting 1.
- Necessary medications can typically be taken with a small sip of water even within the 2-hour window, but this should be specifically discussed with your healthcare provider beforehand.
- It's essential to follow the specific pre-procedure instructions provided by your gastroenterologist or anesthesia provider, as individual circumstances may require adjustments to these general guidelines.
- Preoperative dehydration may be a greater safety concern than drinking clear liquids before anesthesia, as noted in guidelines on optimizing bowel cleansing for colonoscopy 1.
Evidence Summary
The evidence from recent studies and guidelines supports the recommendation to stop drinking water at least 2 hours before the procedure, with a strong consensus (97% agreement) in favor of this approach 1. This is consistent with recommendations from other guidelines, which suggest that clear liquids can be consumed up until 2 hours before anesthesia without increasing the risk of aspiration 1.
From the Research
Stopping Water Intake Before EGD/Colo with Propofol Sedation
- The studies provided do not directly address the question of when to stop drinking water before an EGD/Colo procedure with propofol sedation 2, 3, 4, 5, 6.
- However, the studies focus on the safety and effectiveness of propofol sedation for gastrointestinal endoscopy procedures, including EGD and colonoscopy.
- One study found that the consumption of a bowel preparation agent within 3-4 hours before propofol sedation resulted in a similar residual gastric volume (RGV) and pH as those achieved by more prolonged fasting, with no increased risk of aspiration 2.
- Another study reported that nurse-administered propofol sedation using an age-adjusted standard protocol up to a maximal of 200 mg is safe and practical for outpatient gastrointestinal endoscopy 3.
- A case report highlighted the risk of pulmonary aspiration during procedural sedation for colonoscopy, particularly with positional changes, and managed the patient successfully without oral endotracheal intubation 4.
- Other studies evaluated the safety and effectiveness of low-dose propofol sedation for diagnostic EGD and found it to be safe and practical, with low rates of respiratory depression and complications 5, 6.
- While these studies do not provide a direct answer to the question, they suggest that the risk of aspiration is a concern during propofol sedation for EGD/Colo procedures, and that careful management of the patient's airway and monitoring of vital signs are crucial 2, 3, 4, 5, 6.