Published online Dec 16, 2019. doi: 10.4253/wjge.v11.i12.573
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
Processing time: 203 Days and 4.9 Hours
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.
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.
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.
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.
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.
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.
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.