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Sedation Issues in Colonoscopy: Quality and Economic Considerations

Chapter

Abstract

The use of moderate sedation during colonoscopy has long been a standard US gastroenterology practice; however, the quality and economic considerations associated with sedation, particularly the administration of propofol, should be considered for the future of US endoscopy practice. Standard moderate sedation is usually a benzodiazepine and narcotic. In the past decade, an increasing proportion of colonoscopies are performed with propofol, a sedative–hypnotic drug without analgesic effects. We explore overall risks associated with propofol sedation, including perforation rates, polyp detection rates, and impact of procedure monitoring. Overall, the use of propofol compared with traditional colonoscopy sedation appears to be associated with minimal, if any, increased risks and on a population-level evaluation, this would result in harm to few additional patients. However, literature to definitively eliminate significant differences in colonoscopy quality and harm to patients is lacking. In terms of harm from colonoscopies with propofol sedation, many of these measured events are very rare occurrences that require very large sample sizes to have sufficient power to detect statistically significant risks. Further, there are several key economic issues surrounding propofol use for patients undergoing colorectal cancer screening by colonoscopy that include increased patient expectations, throughput, increased revenue, and payer reimbursement. The gastroenterology and anesthesia communities should determine whether the benefits from anesthesia services are worth the financial costs, particularly in population screening for colorectal cancer where the emphasis is on less-expensive tests to increase access and cost-effectiveness.

Keywords

Colonoscopy Colorectal cancer screening Sedation Propofol Quality Economics Perforation Polyp detection rates 

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Group Health Research InstituteSeattleUSA
  2. 2.Department of MedicineUniversity of Washington School of MedicineSeattleUSA

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