Introduction
Early detection of colon adenomas and polyps lowers the risk of colorectal cancer development. Quality indicators for screening or diagnostic colonoscopy encompass the adenoma detection rate (ADR), polyp detection rate (PDR), and cecal intubation rate (CIR). Previous research on ADR, PDR, and CIR in groups of patients who were deeply sedated with propofol versus those who underwent colonoscopy without sedation is undetermined.
Aims & Methods
The objective of this study was to analyze the effects of deep sedation versus no sedation on ADR, PDR, and CIR in a population of elderly patients.
This was a retrospective cohort study that included adult patients over the age of 60, presenting for a first screening or diagnostic colonoscopy performed in the period from January 2017 to September 2023 at our clinical center. The exclusion criteria were emergency colonoscopies, inflammatory bowel diseases, intent therapeutic colonoscopies, and bowel preparation quality (based on the Boston Bowel Preparation Score, BBPS) of less than 6. Participants’ characteristics were assessed using descriptive statistics. Normal distribution was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. Continuous variables were analyzed using Mann–Whitney test and categorical variables using Chi-square or Fisher exact test. Binary logistic regression was conducted to identify significant predictors of the outcomes. Two-tailed tests were conducted, and statistical significance was considered when p <0.05.
Results
Among 2034 patients (46.4% female; mean age: 70 years) deep sedation was performed in 622 patients (30.6%). Total PDR was 51.65%, ADR was 33.3%, and CIR was 94.25%. Patients' characteristics are shown in table 1.
After adjusting for confounders (age, gender, BMI, BBPS for PDR/ADR and age, gender, BMI, BBPS, previous abdominal/pelvic operation, diverticulosis for CIR) no significant difference was shown in PDR, ADR and CIR between no-sedation and deep sedation groups. Higher BMI (B = .041, p < .01) and male gender (B = .36, p = .02) were independent predictors for ADR.
| No-sedation (N=1412)
| Deep sedation with propofol (N=622)
|
Age*
| 70 (65-76) | 68 (64-73) |
Female gender *
| 655 (46,4%)
| 359 (57,7%)
|
BMI
| 27 (24,3 - 30,5) | 27,1 (23,7 - 29,9) |
BBPS
| 9 (6-9)
| 9 (6-9)
|
PDR
| 731 (51,8%)
| 320 (51,5%)
|
ADR
| 472 (33,5%)
| 202 (32,5%)
|
CIR
| 1316 (93,2%)
| 593 (95,3%)
|
Abdominal/pelvic operation
| 488 (34,6%)
| 186 (29,9)
|
Diverticulosis *
| 523 (37,1%)
| 272 (43,8%)
|
Table 1; Patient s' characteristics, BMI; Body mass index, BBPS; Boston bowel preparation scale, PDR; Polyp detection rate, ADR; Adenoma detection rate, CIR; Cecal intubation rate, *gender χ2(3, N =2034)=27,37, p<0.01, *diverticulosis χ2(1, N =2031)=8,14, p<0.01, *age U=367989, z=-5,78; p<0,01, PDR: χ2(1, N =2033)=0,01, p=.92, ADR: χ2(1, N =2031)=0,17, p=.68
Conclusion
In our mixed cohort of elderly patients undergoing screening and diagnostic colonoscopies, propofol-induced deep sedation did not enhance ADR, PDR, or CIR. Further research is needed to determine the impact of deep sedation on colonoscopy quality parameters in elderly patients.