title: Choice of sedation and its impact on adenoma detection rate in screening colonoscopies.
abstract: BACKGROUND
  Studies have demonstrated that the use of sedation (regardless of type) increases polyp detection rates during colonoscopy. Compared to conscious sedation (CS), propofol sedation (PS) has led to detection of more advanced polyps, yet no apparent difference was found in the overall adenoma detection rate (ADR) in patients undergoing colonoscopy for various reasons. We aimed to assess whether there was a significant difference in the ADR in patients specifically undergoing screening colonoscopies using PS versus CS.
  
  
  METHODS
  This is a retrospective analysis of 699 consecutive patients who underwent inpatient screening colonoscopies at one academic inpatient center. The decision to perform endoscopy using PS versus CS was determined on an individual basis by each provider, taking into account various patient parameters.
  
  
  RESULTS
  No significant difference was noted between ADR or location of detected adenomas between the CS and PS groups. When accounting for each variable, only total endoscopy time of less than 20 min resulted in a statistically significant ADR difference between the two sedation groups (CS: 15.6% vs PS: 21.3%, P = 0.038).
  
  
  CONCLUSIONS
  ADR in screening colonoscopies is not increased by the use of PS compared to CS. While the use of propofol-based anesthesia is clearly associated with increased patient satisfaction and pain levels, the ADR is not enhanced, and its widespread use in screening colonoscopy sedation should still be investigated.
authors.affiliation: Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL; (Rahman Nakshabendi).
authors.forename: Rahman
authors.initials: R
authors.lastname: Nakshabendi
authors.affiliation: Medicine, University of South Alabama, Mobile, AL (Andrew C. Berry).
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Berry
authors.affiliation: Medicine, Division of Gastroenterology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL (Juan C. Munoz, Bijo K. John), USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Munoz
authors.affiliation: Medicine, Division of Gastroenterology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL (Juan C. Munoz, Bijo K. John), USA.
authors.forename: Bijo K
authors.initials: BK
authors.lastname: John
keywords: Adenoma detection rate; colonoscopy; conscious sedation; gastroenterology fellow training; propofol sedation