The Impact of Sedation on Adenoma Detection Rate and Cecal Intubation Rate in Colonoscopy

Abstract

Purpose. To explore the effect of sedation on the quality of colonoscopy. Methods. The data collected from the Digestive Endoscopy Center of Shanghai Tongji Hospital from March 2012 to June 2019 were retrospectively analyzed. The rate of sedation and quality metrics of colonoscopy such as adenoma detection rate (ADR) and cecal intubation rate (CIR) were calculated. The logistic regression model was used to explore the relationship between sedation and quality metrics of colonoscopy. The interaction effects between experience of endoscopists and sedation on quality of colonoscopy was also investigated in subgroups stratified by total number of colonoscopies during career using the logistic regression model. Results. A total of 63,417 colonoscopies including 11,417 colonoscopies without sedation and 52,000 colonoscopies with sedation were enrolled in our study. The proportion of colonoscopy with sedation was 82.0%. The ADR and CIR were all significantly higher in cases with sedation compared with cases without sedation (ADR, 22.5% vs. 17.0%, p < 0.001 ; CIR, 94.7% vs. 91.2%, p < 0.001 ). Multivariate analysis showed that the sedation was an independent factor associated with adenoma detection ( OR = 1.448 , 95% CI: 1.372~1.529, p < 0.001 ) and cecal intubation ( OR = 1.560 , 95% CI: 1.446~1.683, p < 0.001 ). A total of 14 endoscopists with complete colonoscopy data in our database and corresponding 20,949 colonoscopies data were enrolled for further analysis. The logistic regression model yielded a similar result that sedation was an independent factor on adenoma detection and cecal intubation when the factor, experience of endoscopists, was also entered into the model as a confounder (adenoma detection, OR = 1.408 , 95% CI: 1.333~1.487, p < 0.001 ; cecal intubation, OR = 1.601 , 95% CI: 1.482-1.729, p < 0.001 ). Conclusion. Colonoscopy with sedation has a positive effect on ADR and CIR in all endoscopists with different experience of colonoscopy, which makes the quality of colonoscopy better.

Sedation is associated with higher polyp and adenoma detection rates during colonoscopy: a retrospective cohort study

“…Zhao 19 et al found no help on ADR or PDR of sedation, but multivariate analysis for evaluating confounding factors were not performed. Huang and Zhang 7,20 et al found that sedation was a favorable factor to improve ADRs, but the history of colorectal disease didn't been investigated. Khan 21 et al also found that sedation as opposed to no sedation was signi cantly associated with a higher ADR, but only 179 of 24,795 patients underwent unsedated colonoscopies, which was too small to draw robust conclusion.…”

“…Sedation has become a common practice in endoscopic operation over the past decades [5][6][7] . Several previous studies have shown that sedation could reduce pain of patients and improve the operator satisfaction, thus shortened the time of colonoscopy.…”

“…However controversy surrounding the effect of sedation on quality indicator of colonoscopy such as PDR and ADR had been reported in different country, yet little is known about the impact of sedation when controlling the other factors with a largescale cohort. Although some previous studies have reported that sedation has little effect on the PDR and ADR of colonoscopy [5,8,17,18], some studies recently demonstrating the positive effects of sedation on colonoscopy [6,7,[19][20][21][22]. Therefore, more studies are needed to evaluate whether the sedation is bene cial to ADR and PDR.…”

Anesthesia Assistance in Colonoscopy: Impact on Quality Indicators

“…Fatima Khan revealed that colonoscopy with sedation, as opposed to no sedation, was significantly linked to higher ADR ( 37 ). Qiongmei Zhang indicated that sedation was an independent factor associated with higher ADR ( 38 ). A study revealed that midazolam/fentanyl sedation administered by colonoscopists might increase PDR during colonoscopy ( 39 ).…”

Correlation between adenoma detection rate and other quality indicators, and its variability depending on factors such as sedation or indication for colonoscopy

“…In the literature, there are conflicting data regarding the influence of sedation on ADR. In some studies ADR was significantly higher when colonoscopies were performed with sedation (Khan et al, 2020;Zhang et al, 2020), and in others ADR was not influenced by sedation (Bannert et al, 2012;Lee et al, 2014;Zhao et al, 2020) but the frequency of major complications increased among sedated patients (Zhao et al, 2020). We have not found studies in which Frontiers in Pharmacology frontiersin.org sedation negatively influences ADR, and the data we obtained may represent a particularity that deserves to be studied further or may be a false positive finding determined by the limitations of the study.…”