Does deep sedation with propofol affect adenoma detection rates in average risk screening colonoscopy exams?

• 作者: Gottumukkala S Raju Jeffrey H Lee Joseph Ruiz Katherine B Hagan Mala Pande Richard Carlson Selvi Thirumurthi William A Ross
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: 镇静 PROPOFOL 腺瘤察觉率 盲肠的 intubation 率 COLONOSCOPY 优秀度量标准
• 年，卷（期）: 2017,（4）
• 页码范围: 177-182
• 页数: 6页
• 分类号: R614

摘要

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 firsttime 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.