Conscious or unconscious: The impact of sedation choice on colon adenoma detection

Metwally, Mark

doi:10.3748/wjg.v17.i34.3912

Cited by 40 publications

(35 citation statements)

References 11 publications

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“…If patients can tolerate colonoscopy without sedation, the non-left lateral starting position without sedation during colonoscopy may improve the cecal insertion time and reduce the adverse events. Previous studies reported that there was no difference in ADR between colonoscopy with and without sedation [27,28]. Colonoscopy with sedation resulted in a shorter cecal insertion time than colonoscopy under conscious sedation in a previous study [29].…”

Section: Discussionmentioning

confidence: 94%

Efficacy and safety of the starting position during colonoscopy: a systematic review and meta-analysis

Watanabe

Park

Kakehi³

et al. 2020

Endosc Int Open

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Background and study aims We aimed to assess the efficacy and safety of the starting position during colonoscopy. Patients and methods We searched CENTRAL, MEDLINE, EMBASE, and the WHO International Clinical Trials Registry Platform through February 2019 to identify studies reporting the comparison between the right/supine/prone/tilt-down and left lateral starting position during colonoscopy. The primary outcomes were mean cecal insertion time and adverse events requiring medication. Two reviewers performed study selection and risk of bias assessment. We determined the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation method. This study was registered in PROSPERO (CRD42019124360). Results We identified 10 randomized controlled trials (RCTs) (2083 participants), including three trials on right/tilt-down versus left, two trials on supine/prone versus left, respectively. Mean difference in mean cecal insertion time in supine versus left was –41.0 s (95 % confidence interval [CI] –57.3 to –24.7) in one study and in tilt-down versus left was – 37.3 s (95 % CI –72.1 to –2.4; I2 = 58 %) in three studies; however, there were no statistically significant differences in prone/right versus left position (very low certainty of evidence). Four of eight studies noted adverse effects requiring medication (moderate certainty of evidence). One RCT applying the tilt-down position was terminated because of increased occurrence of oxygen desaturation. Conclusion We could not conclusively determine the efficacy and safety of the starting position during colonoscopy because of low certainty of evidence. Further studies are needed to confirm the efficacy and safety of the starting potion during colonoscopy.

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Section: Discussionmentioning

confidence: 94%

Efficacy and safety of the starting position during colonoscopy: a systematic review and meta-analysis

Watanabe

Park

Kakehi³

et al. 2020

Endosc Int Open

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“…When higher levels of sedation are used (using propofol), studies have suggested an increase in ADR; however, these also showed an increase in complication rates, particularly perforation [14]. Conversely, a study of 3252 colonoscopies showed no difference for those receiving propofol and conscious sedation (midazolam and fentanyl) [15]. Current practice of conscious sedation appears to optimise ADR whilst minimising potential complications and therefore if permitted by patient choice and clinical factors should be employed.…”

Section: Use Of Antispasmodics and Sedationmentioning

confidence: 95%

How Can We Improve Adenoma Detection Rate?

Bond

Sarkar

2016

Curr Colorectal Cancer Rep

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Adenoma detection rate (ADR) is a considerable component of colonoscopy quality assurance; it has a clear link to future morbidity and mortality from colorectal cancer. There are a number of potential factors, both modifiable and non-modifiable that can impact upon ADR. Modes of improving ADR include techniques and behaviours during colonoscopy, image enhancement techniques, technological advancements, advancements in endoscope designs, developments in accessories and continued medical education. However, whilst a number of technologies are emerging to improve ADR, at present, it seems that education, team work and optimising current practice will provide the biggest gains in ADR whilst maintaining financial acceptability. The review aims to present a balanced summary of the evidence currently available and does not propose to serve as a guideline.

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“…Colonoscopy remains a widely performed diagnostic modality of screening for colorectal cancer. Detection and subsequent removal of colonic polyps (most notably adenomatous polyps) has been shown to decrease incidence of colorectal cancer [1]. Adenomatous polyps can be missed in up to a quarter of colonoscopies and hence multiple gastrointestinal societies have proposed quality indicators or metrics to uphold competency in colonoscopy [2 -4].…”

Section: Introductionmentioning

confidence: 99%

Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis

et al. 2020

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Background and study aims Choice of sedation (propofol vs opioid/benzodiazepine) has been studied in the literature and has shown variable outcomes. The majority of recent studies have evaluated propofol sedation (PS) versus opioids, benzodiazepines, or a combination of both. We performed a systematic review and meta-analysis of studies comparing PS to other sedation methods to assess the impact on colonoscopy outcomes. Methods Multiple databases were searched and studies of interest were extracted. Primary outcome of the study was adenoma detection rate (ADR) and secondary outcomes included polyp detection rate (PDR), advanced adenoma detection rate (AADR), and cecal intubation rate (CIR). Results A total of 11 studies met the inclusion criteria with a total of 177,016 patients (148,753 and 28,263 in the opioids/benzodiazepine group and PS group, respectively). Overall, ADR (RR: 1.07, 95 % CI 0.99–1.15), PDR (RR: 1.01, 95 % CI 0.93–1.10), and AADR (RR: 1.17, 95 % CI 0.92–1.48) did not improve with the use of PS. The CIR was slightly higher for propofol sedation group (RR 1.02, 95 % CI 1.00–1.03). Conclusion Based on our analysis, PS and opioid/benzodiazepine sedation seem to have comparable ADR. Our results do not favor use of a particular sedation method and the choice of sedation should be individualized based on patient preference, risk factors and resource availability.

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Conscious or unconscious: The impact of sedation choice on colon adenoma detection

Abstract: The type of sedation used during colonoscopy does not affect the number of patients in whom adenomatous polyps are detected.

Cited by 40 publications

References 11 publications

Efficacy and safety of the starting position during colonoscopy: a systematic review and meta-analysis

Efficacy and safety of the starting position during colonoscopy: a systematic review and meta-analysis

How Can We Improve Adenoma Detection Rate?

Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis

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