Conscious or unconscious: the impact of sedation choice on colon adenoma detection.
OBJECTIVE
To determine if anesthesiologist-monitored use of propofol results in improved detection of adenomas when compared with routine conscious sedation.


METHODS
This retrospective study was conducted at two separate hospital-based endoscopy units where approximately 12,000 endoscopic procedures are performed annually, with one endoscopy unit exclusively using anesthesiologist-monitored propofol. Three thousand two hundred and fifty-two patients underwent initial screening or surveillance colonoscopies. Our primary end point was the adenoma detection rate, defined as the number of patients in whom at least one adenoma was found, associated with the type of sedation.


RESULTS
Three thousand two hundred and fifty-two outpatient colonoscopies were performed by five selected endoscopists. At least one adenoma was detected in 27.6% of patients (95% CI = 26.0-29.1) with no difference in the detection rate between the anesthesiologist-propofol and group and the gastroenterologist-midazolam/fentanyl group (28.1% vs 27.1%, P = 0.53).


CONCLUSIONS
The type of sedation used during colonoscopy does not affect the number of patients in whom adenomatous polyps are detected.
Department of Gastroenterology, Norwalk Hospital, 34 Stevens St. Norwalk, CT 06850, USA. mark.metwally@gmail.com
Mark
M
Metwally
Nicholas
N
Agresti
William B
WB
Hale
Victor
V
Ciofoaia
Ryan
R
O'Connor
Michael B
MB
Wallace
Jonathan
J
Fine
Yun
Y
Wang
Seth A
SA
Gross
D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D000758:Anesthesia; D002755:Choice Behavior; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy / Q000379:methods; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000627:therapeutic use; D012189:Retrospective Studies
D006993:Hypnotics and Sedatives; D015742:Propofol