Published online Apr 16, 2017. doi: 10.4253/wjge.v9.i4.177
Peer-review started: June 22, 2016
First decision: July 23, 2016
Revised: January 2, 2017
Accepted: January 16, 2017
Article in press: January 18, 2017
Published online: April 16, 2017
To determine the effect of sedation with propofol on adenoma detection rate (ADR) and cecal intubation rates (CIR) in average risk screening colonoscopies compared to moderate sedation.
We conducted a retrospective chart review of 2604 first-time average risk screening colonoscopies performed at MD Anderson Cancer Center from 2010-2013. ADR and CIR were calculated in each sedation group. Multivariable regression analysis was performed to adjust for potential confounders of age and body mass index (BMI).
One-third of the exams were done with propofol (n = 874). Overall ADR in the propofol group was significantly higher than moderate sedation (46.3% vs 41.2%, P = 0.01). After adjustment for age and BMI differences, ADR was similar between the groups. CIR was 99% for all exams. The mean cecal insertion time was shorter among propofol patients (6.9 min vs 8.2 min; P < 0.0001).
Deep sedation with propofol for screening colonoscopy did not significantly improve ADR or CIR in our population of average risk patients. While propofol may allow for safer sedation in certain patients (e.g., with sleep apnea), the overall effect on colonoscopy quality metrics is not significant. Given its increased cost, propofol should be used judiciously and without the implicit expectation of a higher quality screening exam.
Core tip: This is a retrospective study to evaluate the effect of propofol deep sedation vs opioid/benzodiazepine moderate sedation on adenoma detection rate (ADR) and cecal intubation rate (CIR) colonoscopy quality metrics. After adjusting for confounding variables of age, gender and body mass index, there was no difference seen in ADR or CIR between the two groups.