Does Sedation Type Affect Colonoscopy Perforation Rates?

Abstract

This study shows that propofol administration is associated with an increased risk of colonoscopic perforation among patients undergoing a therapeutic colonoscopy; however, this association was not evident in patients undergoing a diagnostic colonoscopy. Further studies, such as a prospective, randomized clinical trial, should be done to further evaluate this association.

Patient safety under deep sedation for digestive endoscopic procedures

“…We have already mentioned the paper by Adeyemo et al (14), which attributes a 2.5% increase in perforations to propofol administration by anesthesiologists. Other claims along these lines have been published, whose scientific rigor cannot stand up to the slightest analysis.…”

“…Another statement of Vargo's, based on a paper by Adeyemo et al (14) quoted in the editorial by González-Huix (5), refers to "a 2.5% increase in the number of perforations when propofol is used and administered by anesthesiologists". However, this article surprisingly does not say that it was an anesthesiologist who sedated patients, and recognizes that endoscopist skills were not taken into account, which in our view may be the most important factor for endoscopy-related mechanical complications.…”

“…Most studies referred to with a large number of patients are retrospective, with patients selected from databases designed for a different purpose (8,12,14,19). The retrospective study by Wernli et al (19) discussed data from medical claims regarding over three million colonoscopies.…”

“…The technique's safety when administered by non-anesthesiologists has traditionally raised controversy, usually disguised as scientificism when the real issue is mainly financial in nature, often covered up by dubious debates on the financial sustainability of the health system (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Adult and pediatric anesthesia/sedation for gastrointestinal procedures outside of the operating room

“…Patient data of 118 004 colonoscopies performed between January 2003 and October 2012 were analyzed retrospectively by Adeyemo et al [18]: a rate of colon perforation of 0.04% (n ¼ 48) was identified. In patients undergoing diagnostic colonoscopy, there was no increased risk of colonic perforation with deep sedation compared with conscious sedation; however, therapeutic colonoscopy during deep sedation was associated with a 3.4 times increased risk of colonic perforation [18].…”