title: Does sedation type affect colonoscopy perforation rates?
abstract: BACKGROUND
  Sedation with propofol is gaining popularity. It is unclear whether sedation with propofol is associated with colonoscopic perforation.
  
  
  OBJECTIVE
  The purpose of this study was to compare perforation rates during colonoscopy using sedation with or without propofol.
  
  
  METHODS
  This was a retrospective case series study.
  
  
  METHODS
  Data from a tertiary center were analyzed. Demographics, method of sedation, and type of endoscopic procedure performed were collected.
  
  
  METHODS
  Patients who underwent a colonoscopy from January 2003 to October 2012 were analyzed.
  
  
  METHODS
  Perforation rate expressed per 10,000 colonoscopies was measured.
  
  
  RESULTS
  A total of 118,004 colonoscopies were performed during the study period, with 48 perforations (0.041% or 4.1 per 10,000). Overall, the use of propofol was associated with a 2.5 times increased rate of perforation (6.9 vs 2.7 per 10,000; p = 0.0015). Similarly, in patients undergoing therapeutic colonoscopies, there was a 3.4-times increased risk of perforation associated with the use of propofol (8.7 vs 2.6 per 10,000; p = 0.0016). However, in patients undergoing diagnostic colonoscopies, there was no significantly increased risk of perforation with the use of propofol (4.2 vs 2.9 per 10,000; p = 0.64). In univariate and multivariate analyses, there were no differential perforation risks on the basis of sex, but each decade increase in age was associated with an increased risk of perforation. In those patients having a therapeutic colonoscopy, age (per decade) and propofol use were independently and significantly associated with an increased perforation risk, with adjusted ORs of 1.32 (p = 0.04) and 3.38 (p = 0.001).
  
  
  CONCLUSIONS
  This was a retrospective study with the potential for selection bias.
  
  
  CONCLUSIONS
  This study shows that propofol administration is associated with an increased risk of colonoscopic perforation among patients undergoing a therapeutic colonoscopy; however, this association was not evident in patients undergoing a diagnostic colonoscopy. Further studies, such as a prospective, randomized clinical trial, should be done to further evaluate this association.
authors: 1Department of Surgery, William Beaumont Hospital, Royal Oak, Michigan 2Beaumont Research Institute, William Beaumont Hospital, Royal Oak, Michigan 3Division of Colon and Rectal Surgery, William Beaumont Hospital, Royal Oak, Michigan.
authors: Adewunmi
authors: A
authors: Adeyemo
authors: Mohsen
authors: M
authors: Bannazadeh
authors: Thomas
authors: T
authors: Riggs
authors: Jason
authors: J
authors: Shellnut
authors: Donald
authors: D
authors: Barkel
authors: Harry
authors: H
authors: Wasvary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods; D054810:Deep Sedation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015742:Propofol; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol