Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2017; 9(4): 177-182
Published online Apr 16, 2017. doi: 10.4253/wjge.v9.i4.177
Does deep sedation with propofol affect adenoma detection rates in average risk screening colonoscopy exams?
Selvi Thirumurthi, Gottumukkala S Raju, Mala Pande, Joseph Ruiz, Richard Carlson, Katherine B Hagan, Jeffrey H Lee, William A Ross
Selvi Thirumurthi, Gottumukkala S Raju, Mala Pande, Jeffrey H Lee, William A Ross, Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Joseph Ruiz, Richard Carlson, Katherine B Hagan, Department of Anesthesiology and Peri Operative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: Thirumurthi S performed the research and wrote the paper; Raju GS and Lee JH provided clinical advice and reviewed the manuscript; Pande M performed the statistical analysis; Ruiz J, Carlson R and Hagan KB reviewed the manuscript; Ross WA designed the study, performed the research, reviewed and edited the manuscript.
Supported by the National Cancer Institute of the National Institutes of Health (in part), No. K07CA160753 to Pande M.
Institutional review board statement: This study was approved by the MD Anderson Cancer Center IRB.
Informed consent statement: Patients were not required to give informed consent for this study because the analysis used de-identified clinical data that were obtained in the course of usual patient care that was previously authorized by the patient.
Conflict-of-interest statement: All authors disclosed no financial relationships and no conflicts of interest relevant to this article.
Data sharing statement: No additional data are available.
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/
Correspondence to: William Ross, MD, Professor, Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1466, Houston, TX 77030, United States. wross@mdanderson.org
Telephone: +1-713-7944073 Fax: +1-713-7944421
Received: June 21, 2016
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
Processing time: 297 Days and 16.3 Hours
Abstract
AIM

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.

METHODS

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).

RESULTS

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).

CONCLUSION

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.

Keywords: Sedation; Propofol; Adenoma detection rate; Cecal intubation rate; Colonoscopy; Quality metrics

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.