Sedation for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Guideline.

Key Takeaways for GI Nurses

• Informed consent discussions must explicitly include sedation as a distinct component, aligning with the ESGE Position Statement on informed consent — nurses involved in the consent process should ensure this is documented and communicated to patients.
• Risk stratification is central to safe sedation practice: high-risk patients require more rigorous pre-assessment, individualized sedation regimens, and enhanced periprocedural monitoring, meaning nursing pre-procedure screening protocols take on added clinical weight.
• Sedation planning is not one-size-fits-all — the complexity of the endoscopic procedure (duration and invasiveness) should directly inform the level of pre-assessment, choice of sedation regimen, and intensity of monitoring nurses provide.
• Patients on GLP-1 receptor agonists (increasingly common with the rise of semaglutide and similar medications) require individualized sedation management, likely reflecting concerns about delayed gastric emptying and aspiration risk — nurses should flag this medication history during pre-assessment.

Clinical Relevance

This updated joint ESGE/ESGENA guideline reinforces the nurse's integral role throughout the sedation pathway, from pre-procedure consent conversations to intraprocedural monitoring and recovery. The explicit inclusion of sedation within informed consent requirements means nursing staff involved in patient intake and consent verification should confirm that sedation risks, alternatives, and expectations have been clearly discussed — not just procedural risks. This is an area where documentation gaps commonly occur and where nurses often serve as the final safeguard before the procedure begins.

The emphasis on risk-stratified and procedure-stratified sedation planning has direct operational implications. Units will need robust, nurse-led pre-assessment protocols capable of identifying high-risk patients (e.g., significant cardiopulmonary comorbidity, obesity, obstructive sleep apnea, or anticipated difficult airway) and matching them to appropriate monitoring resources — which may mean escalating from standard pulse oximetry and clinical observation to capnography or anesthesia-supported sedation for complex or prolonged procedures such as ERCP or EUS. Nurses should expect updated unit protocols defining clear thresholds for when enhanced monitoring or physician/anesthetist involvement is warranted based on both patient risk and procedural complexity.

The new recommendation regarding GLP-1 receptor agonists is particularly timely given the rapid increase in patients prescribed these medications for diabetes and weight management. Since the guideline calls for individualized management rather than a blanket protocol, nursing teams will need to incorporate structured questioning about GLP-1 agonist use into pre-assessment, and units should anticipate developing local pathways (e.g., modified fasting instructions, aspiration precautions, or discussion with the endoscopy team) in collaboration with physicians, since the guideline stops short of mandating a single approach.

Bottom Line

For busy GI nurses, this guideline underscores that sedation safety is not a one-time checklist but a dynamic, individualized process shaped by patient risk, procedural complexity, and now medication history (notably GLP-1 receptor agonists) — making thorough nursing pre-assessment and tailored periprocedural monitoring more critical than ever to preventing sedation-related adverse events.