How survivors of exploitation who use drugs navigate systems of care: an analysis of survivor insights using the intersectional risk environment.

Gastrointestinal (GI) diseases are highly prevalent and represent a global health burden []. Thus, there is mounting attention to early diagnostic and therapeutic interventions such as endoscopy []. Endoscopic procedures are a cornerstone in the early detection and ongoing management of common GI conditions, such as peptic ulcers, gastroesophageal reflux disease (GERD), inflammatory bowel diseases (IBD), strictures, and various GI malignancies []. Moreover, these minimally invasive approaches are milestones not only for visualization and biopsy of the GI tract but also to enable subsequent therapeutic interventions [, ]. GI procedures are inherently irritating and often associated with abdominal discomfort, cramping, gagging, and choking sensations. Their fear and anxiety may limit patients’ readiness to undergo an endoscopy because of the expected discomfort and pain, which may also interfere with the endoscopist's ability to perform the procedure appropriately []. Endoscopies require sedation to relieve patients' discomfort and facilitate the endoscopist’s technical operation []. Sedation is an essential step in the success of endoscopy, as it enhances patient comfort, reduces anxiety, and improves the quality of the technique []. As a result, an emerging focus is on optimizing sedative agents during endoscopic procedures, and among these agents []. The best analgesics and sedatives should have a high safety profile, maximize cost-effectiveness, act rapidly with rapid offset, and not accumulate []. Nowadays, sedatives and analgesic medications include opioids, propofol, midazolam, etomidate, and dexmedetomidine [].