Optimized Sedation Improves Colonoscopy Quality Long-Term

Abstract

Background. Quality monitoring and improvement is prerequisite for efficient colonoscopy. Aim. To assess the effects of increased sedation administration on colonoscopy performance. Materials and Methods. During Era 1 we prospectively measured four colonoscopy quality indicators: sedation administration, colonoscopy completion rate, adenoma detection rate, and early complications rate in three cohorts: cohort A: intention for total colonoscopy cases; cohort B: cohort A excluding bowel obstruction cases; cohort C: CRC screening-surveillance cases within cohort B. We identified deficiencies and implemented our plan to optimize sedation. We prospectively evaluated its effects in both short- (Era 2) and long-term period (Era 3). Results. We identified that sedation administration and colonoscopy completion rates were below recommended standards. After sedation optimization its use rate increased significantly (38.1% to 55.8% to 69.5%) and colonoscopy completion rate increased from 88.3% to 90.6% to 96.4% in cohort B and from 93.2% to 95.3% to 98.3% in cohort C, in Eras 1, 2, and 3, respectively. Adenoma detection rate increased in cohort C (25.9% to 30.6% to 35%) and early complications rate decreased from 3.4% to 1.9% to 0.3%. Most endoscopists increased significantly their completion rate and this was preserved long-term. Conclusion. Increased sedation administration results in long-lasting improvement of colonoscopy quality indicators.

Predictors of Failed Conscious Sedation in Patients Undergoing an Outpatient Colonoscopy and Implications for the Adenoma Detection Rate

“…ADR has previously been linked to patient factors such as age, race, gender, comorbidities, and procedural factors -most notably withdrawal time and even endoscopist personality [23][24][25][26] . In addition, studies have also analysed differences in the ADR between sedated and unsedated patients with some showing clear benefit for sedation 27 and others showing no difference 28,29 . Studies comparing ADRs in patients sedated with CS and MAC have demonstrated either no difference 30 or a benefit to CS over MAC 29 .…”

How Can We Improve Adenoma Detection Rate?

“…This is evidenced when you consider the results of a study that demonstrated a larger amount of mono or dual (conscious) sedation improved many aspects of colonoscopy assurance measures. ADR increased (25.9 to 35 %), early complications rate decreased (3.4 to 0.3 %) and completion rates increased (88.3 to 96.4 %) [13]. When higher levels of sedation are used (using propofol), studies have suggested an increase in ADR; however, these also showed an increase in complication rates, particularly perforation [14].…”

Target-Controlled Infusion of Propofol in Training Anesthesiology Residents in Colonoscopy Sedation: A Prospective Randomized Crossover Trial

“…Colonoscopy has been widely performed to screen colorectal diseases. Most of the procedures are performed under sedation and/or analgesia due to the discomfort or pain, [ 1 , 2 ] and adequate sedation may improve the quality of colonoscopy [ 3 , 4 ]. Sedation for endoscopy can be classified into minimal, moderate, and deep sedation, depending on the different types of procedures, and moderate sedation level is regarded as the minimal requirement for colonoscopy [ 5 , 6 ].…”