Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2019; 11(12): 573-588
Published online Dec 16, 2019. doi: 10.4253/wjge.v11.i12.573
Propofol vs traditional sedatives for sedation in endoscopy: A systematic review and meta-analysis
Aureo Augusto de Almeida Delgado, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Ahmad Najdat Bazarbashi, Marcos Eduardo Lera dos Santos, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Aureo Augusto de Almeida Delgado, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Marcos Eduardo Lera dos Santos, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403000, Brazil
Diogo Turiani Hourneaux de Moura, Ahmad Najdat Bazarbashi, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Author contributions: Delgado AAA contributed to the acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; de Moura DTH contributed to the analysis and interpretation of data, revising the article; Ribeiro IB contributed to the acquisition of data, drafting the article, revising the article, final approval; Bernardo WM contributed to the analysis and interpretation of data, drafting the article, final approval; Bazarbashi AN contributed to the revising, editing and drafting article, final approval; dos Santos MEL and de Moura EGH contributed to the analysis and interpretation of data, drafting the article, revising the article, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors revised the manuscript according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Igor Braga Ribeiro, MD, Surgeon, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo 05403-010, Brazil. igorbraga1@gmail.com
Telephone: +55-9-2981377788 Fax: +55-1-126616467
Received: May 6, 2019
Peer-review started: May 8, 2019
First decision: August 2, 2019
Revised: August 17, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: December 16, 2019
ARTICLE HIGHLIGHTS
Research background

Endoscopy has transformed over the past several decades to encompass significant advances and procedural innovation, with the hope to provide better care for ill patients. However, with technical advances and innovation comes increasingly prolonged and complex procedures. This change in the endoscopic platform, alongside the higher acuity of patients, has demanded a change in the approach for procedural sedation to ensure safe interventions.

Research motivation

The change in the sedation landscape for endoscopy over the past several decades necessitates a better understanding of sedation types and how they compare to each other for the modern practicing endocsopist.

Research objectives

We aimed to compare sedation with propofol, alone or in combination with adjunctive sedations, to traditional sedation in endoscopy through a systematic review of the literature and meta-analysis.

Research methods

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in International Prospective Register of Systematic Reviews international database. The search was performed in the electronic databases MEDLINE (via PubMed), LILACS (via BVS) and Cochrane/Central Register of Controlled Trials. The quality of the selected papers was evaluated by Jadad score and all articles used were selected by consensus of three authors.

Research results

A total of 23 clinical trials (n = 3854), from an initial search of 6410 articles, were included. For Group I (Propofol vs benzodiazepine and/or opioids): The incidence of bradycardia, hypotension, oxygen desaturation and post procedure recovery time was not statistically different between both arms. For Group II (Propofol vs propofol with benzodiazepine and/or opioids): Bradycardia tended to occur in the propofol group with benzodiazepine and/or opioid-associated but there was no statistical difference in the incidence of bradycardia, desaturation or recovery time between sedation arms. For Group III (Propofol with benzodiazepine and opioid vs benzodiazepine and opioid): Bradycardia, desaturation and, hypotension was not statistically significant between groups.

Research conclusions

Our findings suggest that the use of propofol alone or in combination with traditional adjunctive sedatives is safe and does not result in an increase in negative outcomes in patients undergoing endoscopic procedures.

Research perspectives

Future studies should consider methods for standardization of sedation use to allow for less heterogeneity amongst studies and to improve analysis in future metanalyses to come. Future studies should also highlight cost effectiveness of various sedations used.