Limitations
obesity, diabetes
ADVERSE EVENTS, OBESITY, DIABETES
This study has several limitations that should be acknowledged. First, we administered low-dose esketamine in combination with propofol and sufentanil to achieve adequate efficacy and safety in our patients. However, the optimal sedation regimen for endoscopic procedures is an area that still requires further investigation. Therefore, future research should continue exploring and refining the most effective and safe sedation protocols. Second, the subgroup analysis revealed a significant heterogeneity between patients with and without diabetes. However, this finding may have been influenced by the relatively small number of patients with diabetes included in the analysis. To validate and draw more robust conclusions from this result, additional studies with a larger and more balanced representation of patients with diabetes are warranted. Third, this trial was not powered to detect differences in other adverse events. Fourth, for this study, we specifically included patients aged 18 to 70 years with an ASA physical status I or II and a BMI between 18 and 30. Although these selection criteria allowed us to observe the treatment effects of esketamine in this specific patient population, they may not fully capture the effects in other age groups, those with higher ASA classifications, or individuals with obesity. Therefore, future research should explore the use of esketamine in different patient populations to gain a comprehensive understanding of its efficacy and safety across various demographics. Despite these limitations, our study provides valuable insights into the benefits of low-dose esketamine as an adjuvant to propofol-based sedation for same-visit bidirectional endoscopy. Further research and larger trials will be essential to optimize sedation strategies, confirm the subgroup findings, and extend the applicability of esketamine to broader patient populations undergoing endoscopic procedures.