Does level of sedation impact detection of advanced neoplasia?
OBJECTIVE
Two of the foremost issues in screening colonoscopy involve delivering quality and maximizing adenoma detection rates (ADR). Little is known about the impact of deep sedation on ADR. This study aims to compare the detection of advanced lesions during screening colonoscopy performed with moderate conscious sedation (MCS) versus deep sedation (DS).


METHODS
A retrospective cohort study was performed using the Clinical Outcomes Research Initiative database. Average risk screening colonoscopies performed January 2000 to December 2005 were examined for practice setting, patient demographics, and findings, including detection of a polyp >9 mm and suspected malignant lesions.


RESULTS
A total of 104,868 colonoscopies were examined, 97% of which were performed with MCS. Univariate analysis demonstrated that more polyps of any size were detected with MCS (38 vs. 34%, p < 0.0001) and more advanced lesions were found with DS compared with MCS (7 vs. 6%, p = 0.01). When exclusively examining sites that performed DS > 10% for all procedures, a more significant increase in advanced lesion detection when using DS was observed (7.5 vs. 5.7%, p = 0.003). When adjusted for age, gender, race/ethnicity, site, prep quality, and ASA group, DS was 25% more likely to detect an advanced lesion.


CONCLUSIONS
Our data suggest that use of DS may be associated with a higher rate of advanced lesion detection. However, this retrospective design has limitations that necessitate follow-up with prospective studies. These follow-up studies would be essential to support any change in the standard practices of sedation.
Wang
A
A
Department of Gastroenterology, Oregon Health and Science University, Portland, OR 97239, USA. wangamy@ohsu.edu
Hoda
K M
KM
Holub
J L
JL
Eisen
G M
GM
D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000592:standards*; D016292:Procedural Sedation; D054810:Deep Sedation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
N Engl J Med. 2005 May 19;352(20):2061-8
15901859
Am J Gastroenterol. 2005 May;100(5):996-1000
15842568
J Natl Cancer Inst. 1991 Mar 6;83(5):359-61
1995919
Gastroenterology. 1997 Jan;112(1):24-8
8978338
Clin Gastroenterol Hepatol. 2008 Oct;6(10):1091-8
18639495
Clin Gastroenterol Hepatol. 2005 Aug;3(8):798-805
16234009
Gastrointest Endosc. 2005 Mar;61(3):378-84
15758907
N Engl J Med. 2000 Nov 30;343(22):1603-7
11096167
N Engl J Med. 2006 Dec 14;355(24):2533-41
17167136
J Natl Med Assoc. 2007 Jul;99(7):723-8
17668638
Gastrointest Endosc. 2003 Jul;58(1):76-9
12838225
JAMA. 2008 Sep 24;300(12):1417-22
18812532
Lancet. 1996 Nov 30;348(9040):1467-71
8942774
Am J Gastroenterol. 2005 Mar;100(3):515-23; discussion 514
15743345
Gastroenterology. 2008 Oct;135(4):1100-5
18691580
Cancer Epidemiol Biomarkers Prev. 2007 Aug;16(8):1543-6
17684126
JAMA. 2006 Dec 20;296(23):2815-22
17179458
Am J Epidemiol. 1998 Apr 1;147(7):670-80
9554606
J Natl Cancer Inst. 1995 Feb 15;87(4):265-73
7707417
N Engl J Med. 2000 Jul 20;343(3):169-74
10900275
Gastrointest Endosc. 2008 Mar;67(3):489-96
18179793
J Natl Cancer Inst. 2007 Nov 21;99(22):1729-35
18000222
N Engl J Med. 1993 Dec 30;329(27):1977-81
8247072
J Clin Gastroenterol. 2008 Jul;42(6):704-7
18496392
Lancet. 1996 Nov 30;348(9040):1472-7
8942775
Ann Intern Med. 2004 Sep 7;141(5):352-9
15353426
Cancer Epidemiol Biomarkers Prev. 2001 Jul;10(7):725-31
11440957
Gastrointest Endosc. 2005 Dec;62(6):875-83
16301030
N Engl J Med. 2000 Jul 20;343(3):162-8
10900274