Moderate versus deep sedation in adults undergoing colonoscopy: systematic review and meta-analysis

Lim, Seho; Lee, Oh Haeng; Yoon, Il Jae; Choi, Geun Joo; Kang, Hyun

doi:10.1080/03007995.2018.1552040

Cited by 8 publications

(15 citation statements)

References 24 publications

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“…In accordance with our results, a retrospective study showed that sedated and non‐sedated colonoscopy did not result in any differences in colonoscopy performance . Also, a recent meta‐analysis found that recovery time from deep sedation was the same as that from moderate sedation . Different dosages of sedative drugs, not different sedative agents, resulted in different recovery time between sequences.…”

Section: Discussionsupporting

confidence: 90%

Optimal sequences of same‐visit bidirectional endoscopy: Systematic review and meta‐analysis

Laoveeravat

Thavaraputta

Suchartlikitwong

et al. 2019

Digestive Endoscopy

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Background and Aim Same‐visit colonoscopy and esophagogastroduodenoscopy (EGD) have become common. Recent studies showed conflicting results regarding the performance, safety, and efficacy of different sequences. We conducted this meta‐analysis to determine the most favorable performance and discomfort between an EGD followed by colonoscopy (E‐C) and colonoscopy followed by EGD (C‐E). Methods The authors searched the databases of MEDLINE and EMBASE. Outcomes of interest were performance (including cecal intubation time, adenoma detection rate, and polyp detection rate), discomfort score (patients and endoscopists; Likert scale), and sedation uses. Pooled mean differences (MD) or odds ratios (OR) were calculated with 95% confidence intervals (CI). Results Six randomized controlled trials were included in the meta‐analysis. The authors found that there was significantly lower sedative use including fentanyl (14.70; 95% Cl: 8.20–21.20) and propofol (15.58; 95% Cl: 3.27–27.89) in the E‐C group compared with the C‐E group. There was a significantly better discomfort score in patients and endoscopists after both procedures in the E‐C group than in the C‐E group with pooled MD of 0.64 points (95% Cl: 0.09–1.20) and 0.47 (95% Cl: 0.05–0.90), respectively. There were no differences in cecal intubation time, adenoma detection rate, or polyp detection rate between the two groups. Conclusion The present study found that the discomfort score was better in the E‐C group. However, there was no difference in polyp and adenoma detection. Therefore, the E‐C group is the optimal sequence.

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Section: Discussionsupporting

confidence: 90%

Optimal sequences of same‐visit bidirectional endoscopy: Systematic review and meta‐analysis

Laoveeravat

Thavaraputta

Suchartlikitwong

et al. 2019

Digestive Endoscopy

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“…Moderate or conscious sedation is safer and more cost efficient than deep sedation 25 . However, since there are very few studies in which analgesics alone have been used to treat pain during a colonoscopy, comparing sedation levels to those in other studies is difficult.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a transmucosal sublingual fentanyl tablet as a procedural pain treatment in colonoscopy patients: a prospective placebo-controlled randomized study

Fihlman

Karru

Varpe

et al. 2020

Sci Rep

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Since patients often experience pain and unpleasantness during a colonoscopy, the present study aimed to evaluate the efficacy and safety of sublingually administered fentanyl tablets for pain treatment. Furthermore, since the use of intravenous drugs significantly increases colonoscopy costs, sublingual tablets could be a cost-effective alternative to intravenous sedation. We conducted a prospective placebo-controlled randomized study of 158 patients to evaluate the analgesic effect of a 100 µg dose of sublingual fentanyl administered before a colonoscopy. Pain, sedation, nausea, and satisfaction were assessed during the colonoscopy by the patients as well as the endoscopists and nurses. Respiratory rate and peripheral arteriolar oxygen saturation were monitored throughout the procedure. There were no differences between the fentanyl and placebo groups in any of the measured variables. The median pain intensity values, as measured using a numerical rating scale, were 4.5 in the fentanyl group and 5 in the placebo group. The sedation and oxygen saturation levels and the respiratory rate did not differ between the groups. The majority of the colonoscopies were completed.Our results indicate that a 100 µg dose of sublingual fentanyl is not beneficial compared to the placebo in the treatment of procedural pain during a colonoscopy.

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“…Its increased cost and thus higher economic healthcare burden is a reasonable concern [6,22]. In addition, the setting and personnel required to provide PS, can limit its availability in certain endoscopic centers [5,6]. Potential utilization of nurse-administered propofol sedation (NAPS) method as pointed out by Rex et al can address both major concerns i. e. high cost and safe administration of the drug [23,24].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, two methods of sedation are most commonly used to achieve patient relaxation and thus compliance during the colonoscopy exam: opioid/benzodiazepine sedation (OBS) i. e. conscious sedation, as well as propofol-based sedation (PS) [5]. Use of OBS generally entails gastroenterologist-monitored use of an opioid and a benzodiazepine or a combination of both agents while PS, which can be administered via an anesthesiologist, a nurse anesthetist, or a nurse working closely with the endoscopists, has been increasingly utilized recently to achieve a deeper level of sedation to further increase patient satisfaction.…”

Section: Introductionmentioning

confidence: 99%

“…Use of OBS generally entails gastroenterologist-monitored use of an opioid and a benzodiazepine or a combination of both agents while PS, which can be administered via an anesthesiologist, a nurse anesthetist, or a nurse working closely with the endoscopists, has been increasingly utilized recently to achieve a deeper level of sedation to further increase patient satisfaction. [1,5] A recent meta-analysis that compared PS with OBS did not reveal any statistically significant increase in patient satisfaction (RR = 0.94, 95 % CI 0.86-1.04), physician satisfaction (RR = 0.35, 95 % CI 0.02-6.95), and recovery time (mean difference =-6.77, 95 % CI-16.21-2.67) [5]. Randomized controlled trials (RCTs) and cohort studies comparing use of OBS vs PS for colonoscopy have shown varying results in terms of differences in ADR, PDR, AADR, and CIR [6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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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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Moderate versus deep sedation in adults undergoing colonoscopy: systematic review and meta-analysis

Cited by 8 publications

References 24 publications

Optimal sequences of same‐visit bidirectional endoscopy: Systematic review and meta‐analysis

Optimal sequences of same‐visit bidirectional endoscopy: Systematic review and meta‐analysis

Feasibility of a transmucosal sublingual fentanyl tablet as a procedural pain treatment in colonoscopy patients: a prospective placebo-controlled randomized study

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

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