Indian Journal of Gastroenterology

, Volume 37, Issue 2, pp 86–91 | Cite as

No increased risk of perforation during colonoscopy in patients undergoing propofol versus traditional sedation: A meta-analysis

  • Minmin Xue
  • Jian Tian
  • Jing Zhang
  • Hongbin Zhu
  • Jun Bai
  • Sujuan Zhang
  • Qili Wang
  • Shuge Wang
  • Xuzheng Song
  • Donghong Ma
  • Jia Li
  • Yongmin Zhang
  • Wei Li
  • Dongxu Wang
Original Article
  • 19 Downloads

Abstract

Background and Aims

The safety of propofol sedation during colonoscopy remains unclear, and we performed a meta-analysis to assess the risk of perforation in patients undergoing propofol vs. traditional sedation.

Methods

MEDLINE, CBM, VIP, CNKI, and Wanfang databases were searched up to December 2016. Two reviewers independently assessed abstract of those searched articles. Data about perforation condition in propofol and traditional sedation groups were extracted and combined using the random effects model.

Results

A total of 19 studies were included in the current meta-analysis. Compared to traditional sedation, propofol sedation did not increase the risk of perforation (RD = − 0.00, 95% CI − 0.00~0.00, p = 0.98; subgroup analysis: OR = 1.30, 95% CI 0.83~2.05, p = 0.25).

Conclusion

This meta-analysis suggested that propofol sedation did not increase the risk of perforation compared to traditional sedation during colonoscopy.

Keywords

Colonoscopy Perforation Propofol sedation Risk 

Notes

Compliance with ethical standards

Conflict of interest

MX, JT, JZ, HZ, JB, SZ, QW, SW, XS, DM, JL,YZ, WL, and DW declare that they have no conflicts of interests.

Ethics statement

There are no ethical issues involved in our study for our data were based on published studies.

Supplementary material

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References

  1. 1.
    Wernli KJ, Brenner AT, Rutter CM, Inadomi JM. Risks associated with anesthesia services during colonoscopy. Gastroenterology. 2016;150:888–94.CrossRefPubMedGoogle Scholar
  2. 2.
    Rabeneck L, Paszat LF, Hilsden RJ, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 2008;135:1899–1906, 906 e1.Google Scholar
  3. 3.
    Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc. 2007;21:994–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Adeyemo A, Bannazadeh M, Riggs T, Shellnut J, Barkel D, Wasvary H. Does sedation type affect colonoscopy perforation rates? Dis Colon Rectum. 2014;57:110–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Javier JP, Gabriela P, Rosario A, David C, Cristina R, Fernando B. Iatrogenic perforation in diagnostic colonoscopy related to the type of sedation. Gastrointest Endosc. 2000;51:AB68.Google Scholar
  6. 6.
    Bastaki M, Douzinas EE, Fotis TG, et al. A randomized double-blind trial of anesthesia provided for colonoscopy by university-degreed anesthesia nurses in Greece: safety and efficacy. Gastroenterol Nurs. 2013;36:223–30.Google Scholar
  7. 7.
    Bielawska B, Day AG, Lieberman DA, Hookey LC. Risk factors for early colonoscopic perforation include non-gastroenterologist endoscopists: a multivariable analysis. Clin Gastroenterol Hepatol. 2014;12:85–92.CrossRefPubMedGoogle Scholar
  8. 8.
    Goudra B, Singh PM, Gouda G, Borle A, Carlin A, Yadwad A. Propofol and non-propofol based sedation for outpatient colonoscopy-prospective comparison of depth of sedation using an EEG based SEDLine monitor. J Clin Monit Comput. 2016;30:551–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Korman LY, Haddad NG, Metz DC, et al. Effect of propofol anesthesia on force application during colonoscopy. Gastrointest Endosc. 2014;79:657–62.Google Scholar
  10. 10.
    Ng JM, Kong CF, Nyam D. Patient-controlled sedation with propofol for colonoscopy. Gastrointest Endosc. 2001;54:8–13.CrossRefPubMedGoogle Scholar
  11. 11.
    Okholm C, Hadikhadem T, Andersen LT, Donatsky AM, Vilmann P, Achiam MP. No increased risk of perforation during colonoscopy in patients undergoing nurse administered propofol sedation. Scand J Gastroenterol. 2013;48:1333–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Sipe BW, Rex DK, Latinovich D, et al. Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc. 2002;55:815–25.Google Scholar
  13. 13.
    Thornley P, Al Beshir M, Gregor J, Antoniou A, Khanna N. Efficiency and patient experience with propofol vs conventional sedation: a prospective study. World J Gastrointest Endosc. 2016;8:232–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Ulmer BJ, Hansen JJ, Overley CA, et al. Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists. Clin Gastroenterol Hepatol. 2003;1:425–32.Google Scholar
  15. 15.
    Gasparovic S, Rustemovic N, Opacic M, Bates M, Petrovecki M. Comparison of colonoscopies performed under sedation with propofol or with midazolam or without sedation. Acta Med Austriaca. 2003;30:13–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Moerman AT, Foubert LA, Herregods LL, et al. Propofol versus remifentanil for monitored anaesthesia care during colonoscopy. Eur J Anaesthesiol. 2003;20:461–6.Google Scholar
  17. 17.
    Ivano FH, Romeiro PC, Matias JE, et al. Comparative study of efficacy and safety between propofol and midazolam for sedation during colonoscopy. Rev Col Bras Cir. 2010;37:10–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Cohen S, Glatstein MM, Scolnik D, et al. Propofol for pediatric colonoscopy: the experience of a large, tertiary care pediatric hospital. Am J Ther. 2014;21:509–11.Google Scholar
  19. 19.
    Ja W, Pf S, Kn J, Aa H, Pw A. Propofol: multiple advantages for endoscopy and colonoscopy in 1,424 consecutive patients. Gastrointest Endosc. 2000;5:AB59.Google Scholar
  20. 20.
    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.Google Scholar
  21. 21.
    Chen J, Xu J, Yang Y, Yi C. Efficacy of intravenous propofol sedation during routine colonoscopy in children and hypertensive patients. Chin J Dis Endosc 2001;18:346–9.Google Scholar
  22. 22.
    Li W, Zhang S, Ji M, Wu Y, Yu Z. Sedation with midazolam versus propofol in colonoscopies : A prospective randomized and controlled study. Chin J Min Inv Surg. 2007;7:180–2.Google Scholar
  23. 23.
    Pan W, Bo Y, Guo Q, Chen Y, Lou X, LI Y. A comparison of Etomidate and propofol by pumbing for colonoscopy in aged patients. China Health Industry. 2014;12:17–9.Google Scholar
  24. 24.
    Syaed El Ahl MI. Modified sevoflurane-based sedation technique versus propofol sedation technique: A randomized-controlled study. Saudi J Anaesth. 2015;9:19–22.Google Scholar
  25. 25.
    Goudra B, Nuzat A, Singh PM, Borle A, Carlin A, Gouda G. Association between type of sedation and the adverse events associated with gastrointestinal endoscopy: An analysis of 5 years' data from a tertiary center in the USA. Clin Endosc. 2016;50:161–9.Google Scholar
  26. 26.
    Schroeder C, Kaoutzanis C, Tocco-Bradley R, et al. Patients prefer propofol to midazolam plus fentanyl for sedation for colonoscopy: Results of a single-center randomized equivalence trial. Dis Colon Rectum. 2016;59:62-9.Google Scholar
  27. 27.
    Qadeer MA, Vargo JJ, Khandwala F, Lopez R, Zuccaro G. Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis. Clin Gastroenterol Hepatol. 2005;3:1049–56.Google Scholar
  28. 28.
    Birk J, Bath RK. Is the anesthesiologist necessary in the endoscopy suite? A review of patients, payers and safety. Expert Rev Gastroenterol Hepatol. 2015;9:883–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Katherine MH, Jennifer LH, Glenn ME. More large polyps are seen on screening colonoscopy with deep sedation compared with moderate conscious sedation. Gastrointest Endosc. 2009;69:AB119–AB20.Google Scholar
  30. 30.
    Metwally M, Agresti N, Hale WB, et al. Conscious or unconscious: the impact of sedation choice on colon adenoma detection. World J Gastroenterol. 2011;17:3912–5.Google Scholar
  31. 31.
    Sethi S, Wadhwa V, Thaker A, et al. Propofol versus traditional sedative agents for advanced endoscopic procedures: a meta-analysis. Dig Endos. 2014;26:515–24.Google Scholar
  32. 32.
    Bo LL, Bai Y, Bian JJ, Wen PS, Li JB, Deng XM. Propofol vs traditional sedative agents for endoscopic retrograde cholangiopancreatography: a meta-analysis. World J Gastroenterol. 2011;17:3538–43.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Lee TJ, Rutter MD, Blanks RG, et al. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut. 2012;61:1050–7.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Minmin Xue
    • 1
  • Jian Tian
    • 1
  • Jing Zhang
    • 1
  • Hongbin Zhu
    • 1
  • Jun Bai
    • 1
  • Sujuan Zhang
    • 1
  • Qili Wang
    • 1
  • Shuge Wang
    • 1
  • Xuzheng Song
    • 1
  • Donghong Ma
    • 1
  • Jia Li
    • 1
  • Yongmin Zhang
    • 1
  • Wei Li
    • 1
  • Dongxu Wang
    • 1
  1. 1.Department of GastroenterologyChinese People’s Liberation Army 254 HospitalTianjinPeople’s Republic of China

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