Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis.
OBJECTIVE
Even though propofol has better recovery profile than traditional agents, its use is limited because of the perception of increased complication rates. Because an adequately powered trial comparing risk of propofol with traditional agents is lacking, we performed a meta-analysis of the current literature.


METHODS
We searched Medline (1966-October 2004), EMBASE (1980-October 2004), and Cochrane controlled trials registry. The following 4 cardiopulmonary complications were assessed: hypoxia, hypotension, arrhythmias, and apnea. Procedures were divided into 3 groups: esophagogastroduodenoscopy group, colonoscopy group, and endoscopic retrograde cholangiopancreatography/endoscopic ultrasonography group. Pooled odds ratios for complications were calculated for all the procedures combined and then separately for the 3 groups. Random effects models were used for 2-proportion comparisons.


RESULTS
Of the 90 citations identified, 12 original studies qualified for this meta-analysis and included 1161 patients. Of these, 634 received propofol, and 527 received midazolam, meperidine, and/or fentanyl. Most of the included studies were randomized trials of moderate quality and nonsignificant heterogeneity (Cochran Q = 4.81, P = .90). Compared with traditional sedative agents, the pooled odds ratio with the use of propofol for developing hypoxia or hypotension for all the procedures combined was 0.74 (95% confidence interval [CI], 0.44-1.24); for EGD, 0.85 (95% CI, 0.33-2.17); for colonoscopy, 0.4 (95% CI, 0.2-0.79); and for ERCP/EUS, 1.07 (95% CI, 0.38-3.01).


CONCLUSIONS
Propofol sedation during colonoscopy appears to have lower odds of cardiopulmonary complications compared with traditional agents, but for other procedures, the risk of complications is similar.
Qadeer
Mohammed A
MA
Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Vargo
John J
JJ
Khandwala
Farah
F
Lopez
Rocio
R
Zuccaro
Gregory
G
D001049:Apnea / Q000139:chemically induced; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D003113:Colonoscopy / Q000009:adverse effects; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D019160:Endosonography / Q000009:adverse effects; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007022:Hypotension / Q000139:chemically induced; D000860:Hypoxia / Q000139:chemically induced; D008614:Meperidine / Q000009:adverse effects; D008874:Midazolam / Q000009:adverse effects; D016017:Odds Ratio; D015742:Propofol / Q000009:adverse effects*
D006993:Hypnotics and Sedatives; D008614:Meperidine; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol