Guacho JAL, de Moura DTH, Ribeiro IB, da Ponte Neto AM, Singh S, Tucci MGB, Bernardo WM, de Moura EGH. Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials. World J Gastrointest Endosc 2020; 12(8): 241-255 [PMID: 32879659 DOI: 10.4253/wjge.v12.i8.241]
Corresponding Author of This Article
Igor Braga Ribeiro, MD, Research Fellow, 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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
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/
World J Gastrointest Endosc. Aug 16, 2020; 12(8): 241-255 Published online Aug 16, 2020. doi: 10.4253/wjge.v12.i8.241
Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials
John Alexander Lata Guacho, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Alberto Machado da Ponte Neto, Shailendra Singh, Marina Gammaro Baldavira Tucci, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
John Alexander Lata Guacho, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Alberto Machado da Ponte Neto, Marina Gammaro Baldavira Tucci, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
Shailendra Singh, Division of Gastroenterology, Department of Internal Medicine, West Virginia University, Charleston, WV 25304, United States
Author contributions: Guacho JAL and de Moura DTH contributed to acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; Ribeiro IB, da Ponte Neto AM and Singh S contributed to analysis and interpretation of data, revising the article; Tucci M contributed to acquisition of data drafting the article, final approval; Bernardo WM contributed to analysis and interpretation of data, drafting the article, final approval; de Moura EGH contributed to 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 have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised in accordance with this checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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, Research Fellow, 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
Received: March 31, 2020 Peer-review started: March 31, 2020 First decision: June 7, 2020 Revised: June 12, 2020 Accepted: July 18, 2020 Article in press: July 18, 2020 Published online: August 16, 2020 Processing time: 135 Days and 3.6 Hours
ARTICLE HIGHLIGHTS
Research background
Administration of analgesics and intravenous sedation during endoscopy in patients with cirrhosis has several advantages such as patient comfort, reduced discharge time, and early recovery after the procedure. However, proper selection of sedative medications is essential because of the risk of complications mainly due to underlying hepatic dysfunction– which can lead to difficulty in clearance, recirculation, and increased half-life of drugs.
Research motivation
Many diagnostic or therapeutic upper gastrointestinal endoscopy procedures are often performed in cirrhosis, but choosing effective and safe sedative medications can be a real challenge. Therefore, we wanted to compare commonly used sedation protocols in an attempt to understand the best approach.
Research objectives
To perform a systematic review and meta-analysis of Randomized Controlled Trials comparing sedation with propofol and midazolam in patients with cirrhosis undergoing elective endoscopy.
Research methods
We performed a systematic review and meta-analysis using the PRISMA guidelines. Electronic searches were performed using MEDLINE, EMBASE, Central Cochrane, LILACS databases. Only randomized control trials (RCTs) were included. The outcomes studied were procedure time, recovery time, discharge time, and adverse events (bradycardia, hypotension, and hypoxemia).
Research results
Eight randomized clinical trials were included in the final analysis with a total of 596 patients, of whom 302 belonged to the propofol group and 294 to the midazolam group. Procedure time was similar between midazolam and propofol groups; however, the recovery time and discharge time were significantly less in the propofol group. Adverse events were similar in both groups, and no significant difference was found in rates of bradycardia, hypotension, and hypoxemia.
Research conclusions
Our study showed that propofol has shorter recovery and patient discharge time as compared to midazolam with a similar rate of adverse events. These results suggest that propofol should be the preferred agent for sedation in patients with cirrhosis.
Research perspectives
Sedation medications used during endoscopy can differ in outcomes in patients with cirrhosis. Randomized control trials comparing outcomes and adverse events of multiple sedation protocols in patients with cirrhosis should be carried out in the future.
