Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis

Aziz, Muhammad; Weissman, Simcha; Fatima, Rawish; Khan, Zubair; Mohan, Babu P.; Mehta, Tej I; Lee‐Smith, Wade; Hassan, Ammar; Sciarra, Michael; Nawras, Ali; Adler, Douglas G.

doi:10.1055/a-1135-8681

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…Notably, we found the lack of anesthesia was an independent risk factor for missed adenomas, which is consistent with the finding of several latest reports from China and the United States (45,46), indicating an improved ADR with sedated colonoscopy vs unsedated colonoscopy. However, a recent meta-analysis (47) (not including the above 2 latest reports (45,46)) reported similar ADRs between propofol sedation vs opioid/benzodiazepine sedation. Presumably, the difference of using sedation or not using might actually be the critical factor, whereas the choice of sedation type would not affect ADR and inspecting quality (48).…”

Section: Discussionmentioning

confidence: 98%

Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial

et al. 2022

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INTRODUCTION: Although the 9-minute mean withdrawal time (m-WT) is often reported to be associated with the optimal adenoma detection rate (ADR), no randomized trials of screening colonoscopy have confirmed the impact of a 9-minute m-WT on adenoma miss rate (AMR) and ADR. METHODS:A multicenter tandem trial was conducted in 11 centers. Seven hundred thirty-three asymptomatic participants were randomized to receive segmental tandem screening colonoscopy with a 9-minute withdrawal, followed by a 6-minute withdrawal (9-minute-first group, 9MF, n 5 366) or vice versa (6-minute-first group, 6MF, n 5 367). The primary outcome was the lesion-level AMR. RESULTS:The intention-to-treat analysis revealed that 9MF significantly reduced the lesion-level (14.5% vs 36.6%, P < 0.001) and participant-level AMR (10.9% vs 25.9%, P < 0.001), advanced adenoma miss rate (AAMR, 5.3% vs 46.9%, P 5 0.002), multiple adenomas miss rate (20.7% vs 56.5%, P 5 0.01), and high-risk adenomas miss rate (14.6% vs 39.5%, P 5 0.01) of 6MF without compromising detection efficiency (P 5 0.79). In addition, a lower false-negative rate for adenomas (P 5 0.002) and high-risk adenomas (P < 0.05), and a lower rate of shortening surveillance schedule (P < 0.001) were also found in 9MF, accompanying with an improved ADR in the 9-minute vs 6-minute m-WT (42.3% vs 33.5%, P 5 0.02). The independent inverse association between m-WT and AMR remained significant even after adjusting ADR, and meanwhile, 9-minute m-WT was identified as an independent protector for AMR and AAMR.

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Section: Discussionmentioning

confidence: 98%

Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial

et al. 2022

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“…Prior meta-analyses have summarised the effects of interventions that aim to improve or optimise colonoscopy quality. [13][14][15] However, few studies have attempted to compare the magnitudes of effects of multiple similar interventions by performing NMAs. In the few NMAs that do exist assessing this question, comparisons have been reported across multiple interventional domains, 19 32 with potential heterogeneity in interventions, patient populations and study methodology.…”

Section: Discussionmentioning

confidence: 99%

“…Prior meta-analyses have summarised the effects of interventions that aim to improve or optimise colonoscopy quality 13–15. However, few studies have attempted to compare the magnitudes of effects of multiple similar interventions by performing NMAs.…”

Section: Discussionmentioning

confidence: 99%

“…Several interventions exist that aim to improve ADR. Broadly, these can be categorised into several domains, including preprocedural and periprocedural considerations (eg, optimised bowel cleansing 13 and sedation regimens 14 ), endoscopist-directed interventions (eg, directed audit and feedback 15 or educational courses 16 ), intraprocedural techniques (eg, dynamic positional changes 17 or second-look examination 18 ), endoscopy technologies (eg, advanced imaging 19 or computer-aided detection, CADe 19 ), disposable assistive devices (eg, cuffs 20 or rings 21 ) and additive substances (eg, hyoscine-n-butylbromide 22 ).…”

Section: Open Accessmentioning

confidence: 99%

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Interventions to improve the quality of screening-related colonoscopy: protocol for a systematic review and network meta-analysis of randomised controlled trials

et al. 2022

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IntroductionColonoscopy quality can vary depending on endoscopist-related factors. Quality indicators, such as adenoma detection rate (ADR), have been adopted to reduce variations in care. Several interventions aim to improve ADR, but these fall into several domains that have traditionally been difficult to compare. We will conduct a systematic review and network meta-analysis of randomised controlled trials evaluating the efficacies of interventions to improve colonoscopy quality and report our findings according to clinically relevant interventional domains.Methods and analysisWe will search MEDLINE (Ovid), PubMed, EMBASE, CINAHL, Web of Science, Scopus and Evidence-Based Medicine from inception to September 2022. Four reviewers will screen for eligibility and abstract data in parallel, with two accordant entries establishing agreement and with any discrepancies resolved by consensus. The primary outcome will be ADR. Two authors will independently conduct risk of bias assessments. The analyses of the network will be conducted under a Bayesian random-effects model using Markov-chain Monte-Carlo simulation, with 10 000 burn-ins and 100 000 iterations. We will calculate the ORs and corresponding 95% credible intervals of network estimates with a consistency model. We will report the impact of specific interventions within each domain against standard colonoscopy. We will perform a Bayesian random-effects pairwise meta-analysis to assess heterogeneity based on the I2statistic. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework for network meta-analyses.Ethics and disseminationOur study does not require research ethics approval given the lack of patient-specific data being collected. The results will be disseminated at national and international gastroenterology conferences and peer-reviewed journals.PROSPERO registration numberCRD42021291814.

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“…3 Additionally, there seems to be no direct medical benefit to the deeper sedation in this study or others. 4,5 Would an additional out-of-pocket cost to the patient outweigh the improved satisfaction score? If there is no additional medical benefit (ie, improvement in quality-adjusted life-years), should society bear the increased cost of sedation for this procedure?…”

mentioning

confidence: 99%

Patient Satisfaction, at What Cost?

Vaughn

2022

Clinical Gastroenterology and Hepatology

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Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis

Cited by 10 publications

References 27 publications

Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial

Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial

Interventions to improve the quality of screening-related colonoscopy: protocol for a systematic review and network meta-analysis of randomised controlled trials

Patient Satisfaction, at What Cost?

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