Sedation Is Associated with Higher Polyp and Adenoma Detection Rates during Colonoscopy: A Retrospective Cohort Study

Xu, Chenghu; Tang, Dehua; Xie, Ying; Ni, Muhan; Chen, Min; Shen, Yonghua; Dou, Xiaotan; Zhou, Lin; Xu, Guifang; Wang, Lei; Lv, Ying; Zhang, Shu; Zou, Xiaoping

doi:10.1155/2023/1172478

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…However, they did not specify the sedation type evaluated in their analysis. 19 An important distinction of our study is that the analysis leverages the population-based New Hampshire Colonoscopy Registry, which includes data on essential clinical quality and procedural measures, such as adequacy of bowel preparation, detailed polyp histology, polyp location, size, and examination completion status since 2004. This level of detail allows for multivariable regression analyses to adjust for important covariates while maintaining robust restricted samples.…”

Section: Sedation Type and Colonoscopy Polyp Detectionmentioning

confidence: 99%

Association between Colonoscopy Sedation Type and Polyp Detection: A Registry-based Cohort Study

Quaye,

Hisey,

Mackenzie

et al. 2024

Anesthesiology

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Background Colorectal cancer is a leading cause of cancer-related death. Adenomas and serrated polyps are precursors of colorectal cancer, with serrated polyps being more difficult to detect during colonoscopy. The relationship between propofol use and polyp detection remains unclear. The authors investigated the association of propofol-based versus mild–moderate sedation on adenoma and serrated polyp detection during colonoscopy. Methods This retrospective cohort study used observational data from the New Hampshire Colonoscopy Registry. Patients aged greater than 50 yr with screening or surveillance colonoscopies between January 1, 2015, and February 28, 2020, were included. Exclusions were diagnostic examinations, no sedation, missing pathology data, and poor bowel preparation. Multivariate logistic regression was used to evaluate differences in polyp detection between propofol and moderate sedation in the full sample while adjusting for covariates. Propensity score adjustment and clustering at the endoscopist level were used in a restricted sample analysis that included endoscopists and facilities with between 5% and 95% propofol sedation use. Results A total of 54,063 colonoscopies were analyzed in the full sample and 18,998 in the restricted sample. Serrated polyp prevalence was significantly higher using propofol (9,957 of 29,312; 34.0% [95% CI, 33.4 to 34.5%]) versus moderate sedation (6,066 of 24,751; 24.5% [95% CI, 24.0 to 25.1%]) in the full sample and restricted samples (1,410 of 4,661; 30.3% [95% CI, 28.9 to 31.6%] vs. 3,690 of 14,337; 25.7% [95% CI, 25.0 to 26.5%]). In the full sample multivariate logistic regression, propofol was associated with higher neoplasm (adjusted odds ratio, 1.25 [95% CI, 1.21 to 1.29]), adenoma (odds ratio, 1.07 [95% CI, 1.03 to 1.11]), and serrated polyp detection (odds ratio, 1.51 [95% CI, 1.46 to 1.57]). In the restricted sample using inverse probability of treatment weighted propensity score adjustment and clustering at the endoscopist level, an attenuated but statistically significant effect size was observed for serrated polyps (odds ratio, 1.13 [95% CI, 1.07 to 1.19]), but not for adenomas (odds ratio, 1.00 [95% CI, 0.95 to 1.05]) or any neoplastic lesion (odds ratio, 1.03 [95% CI, 0.98 to 1.08]). Conclusions Propofol sedation during colonoscopy may be associated with improved detection of serrated polyps, but not adenomas. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Sedation Type and Colonoscopy Polyp Detectionmentioning

confidence: 99%

Association between Colonoscopy Sedation Type and Polyp Detection: A Registry-based Cohort Study

Quaye,

Hisey,

Mackenzie

et al. 2024

Anesthesiology

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Does Screening Colonoscopy Have a Future in the United States?

Rex¹,

Ladabaum²,

Anderson³

et al. 2023

Clinical Gastroenterology and Hepatology

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Sedated Colonoscopy may not be Beneficial for Polyp/Adenoma Detection

Han,

Cao,

et al. 2024

Cancer Control

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Background Sedated colonoscopy has been increasingly selected. However, the effect of sedated colonoscopy on polyp/adenoma detection rate (PDR/ADR) remains controversial among studies. Methods In this retrospective study, the medical records of 11 504 consecutive patients who underwent colonoscopy at our department from July 1, 2021 to December 31, 2022 were collected. Patients were divided into sedated and unsedated groups according to the use of intravenous sedation during colonoscopy. Overall PDR/ADR, right-side, transverse, and left-side colon PDR/ADR, and single and multiple PDR/ADR were calculated. By adjusting for age, gender, body mass index, inpatient, screening/surveillance, cecal intubation time, colonoscopy withdrawal time ≥6 min, and an endoscopist’s experience ≥5 years, multivariate logistic regression analyses were performed to evaluate the association of sedated colonoscopy with overall PDR/ADR, right-side, transverse, and left-side colon PDR/ADR, and single and multiple PDR/ADR, where the absence of PDR/ADR was used as reference. Odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated. Results Overall, 2275 patients were included, of whom 293 and 1982 underwent sedated and unsedated colonoscopy, respectively. Multivariate logistic regression analyses showed that sedated colonoscopy was independently associated with lower overall PDR/ADR (OR = 0.640, 95% CI = 0.460-0.889, P = 0.008), right-side colon PDR/ADR (OR = 0.591, 95% CI = 0.417-0.837, P = 0.003), single PDR/ADR (OR = 0.659, 95% CI = 0.436-0.996, P = 0.048), and multiple PDR/ADR (OR = 0.586, 95% CI = 0.402-0.855, P = 0.005), but not transverse or left-side colon PDR/ADR. Conclusion Sedated colonoscopy may not be beneficial in terms of overall PDR/ADR, right-side colon PDR/ADR, and number of polyps/adenomas. Thus, it should be selectively recommended. Additionally, it should be necessary to explore how to improve the quality of sedated colonoscopy.

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Sedation Is Associated with Higher Polyp and Adenoma Detection Rates during Colonoscopy: A Retrospective Cohort Study

Cited by 3 publications

References 31 publications

Association between Colonoscopy Sedation Type and Polyp Detection: A Registry-based Cohort Study

Association between Colonoscopy Sedation Type and Polyp Detection: A Registry-based Cohort Study

Does Screening Colonoscopy Have a Future in the United States?

Sedated Colonoscopy may not be Beneficial for Polyp/Adenoma Detection

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