Propofol Sedation in Colonoscopy: From Satisfied Patients to Improved Quality Indicators

Abstract

Background: Propofol-mediated sedation is safe and clearly associated with increased patient satisfaction. However, whether it results in a favorable effect on colonoscopy outcomes and performance compared to standard sedation with benzodiazepines/opiates remains unclear. Objectives: To determine the effect of propofol-mediated sedation on colonoscopy-quality measures compared to traditional sedation. Methods: A large cohort of 44,794 patients who had undergone sedated colonoscopies were included. Colonoscopy-quality indicators were examined in benzodiazepine/opiate-sedated patients and compared with a propofol-mediated sedation group. Adjustment for potential confounders, such as age, sex, quality of bowel preparation, procedural setting, and indication was performed. Results: Patients who received propofol-mediated sedation were more likely, and in a dosedependent manner, to have an enhanced polyp-detection rate (22.8% vs 20.9%, P<0.001), cecal intubation rate (90.4% vs 87.3%, P<0.001), and terminal ileum-intubation rate (6.4% vs 1.6%, P<0.001). On multivariate analysis, these findings were maintained, as propofol-mediated sedation use was significantly associated with improved colonoscopy indicators. Conclusion: Propofol-mediated sedation during colonoscopy is associated with better examination performance and improved outcomes. Further prospective or randomized trials to support these findings are warranted.

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

“…Of the finalized studies, one was a RCT [8] and 10 were cohort studies [1,6,7,[9][10][11][12][13][14][15]. Risk of bias assessment is shown in Supplementary Table 2 and Supplementary Table 3 for RCT and cohort studies, respectively.…”

“…Eight studies used midazolam and fentanyl specifically for OBS. [1,6,[9][10][11][12][13]15] The total number of patients in both groups was 177,016 (148753 and 28263 in OBS and PS groups, respectively). Both groups (OBS vs PS) were similar in terms of age (range 55.4-64 and 56.7-67) and male gender (53.2 % vs 50.9 %).…”

“…[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]. To further clarify these outcomes, we conducted a systematic review and meta-analysis of these studies to determine whether PS in comparison to OBS improves the aforementioned quality metrics.…”

Confocal laser endomicroscopy under propofol-based sedation for early gastric cancer and pre-cancerous lesions is associated with better diagnosing accuracy: a retrospective cohort study in China

“…Firstly, patients with sedation are able to well tolerate the CLE procedure (13) and endure in ation of the stomach to a great extent, compared to patients without sedation (15). Secondly, adequate level of sedation in CLE may improve the e ciency and quality of the procedure by providing the endoscopist with optimal conditions for a thorough visualization, while eliminating any distraction due to an uncomfortable patient (16). Thirdly, with sedation, the examining time can be prolonged without patient complaints if needed (15).…”

“…It makes endoscopy almost painless, with a very predictable, rapid recovery process and improved patient satisfaction (20,21). Compared with benzodiazepines and opioids, sedation with propofol can improve the quality of endoscopy, such as increasing the detecting rate of advanced lesions (22) and polyp (16). But sedation is also considered with an added risk of complications, especially a risk of cardiopulmonary compromise (23).…”