Association between Colonoscopy Sedation Type and Polyp Detection: A Registry-based Cohort Study

作者：Aurora N. Quaye, William Hisey, Todd A. MacKenzie, Christina M. Robinson, Janelle Richard, Joseph C. Anderson, R. David Warters, Lynn F. Butterly · 发表于：Anesthesiology · 年份：2024 · DOI：10.1097/aln.0000000000004955 · 被引用次数：10 · 研究领域：Colorectal Cancer Screening and Detection、Anesthesia and Sedative Agents、Cancer, Stress, Anesthesia, and Immune Response

BACKGROUND: Colorectal cancer is a leading cause of cancer-related death. Adenomas and serrated polyps are precursors of colorectal cancer, with serrated polyps being more difficult to detect during colonoscopy. The relationship between propofol use and polyp detection remains unclear. The authors investigated the association of propofol-based versus mild-moderate sedation on adenoma and serrated polyp detection during colonoscopy. METHODS: This retrospective cohort study used observational data from the New Hampshire Colonoscopy Registry. Patients aged greater than 50 yr with screening or surveillance colonoscopies between January 1, 2015, and February 28, 2020, were included. Exclusions were diagnostic examinations, no sedation, missing pathology data, and poor bowel preparation. Multivariate logistic regression was used to evaluate differences in polyp detection between propofol and moderate sedation in the full sample while adjusting for covariates. Propensity score adjustment and clustering at the endoscopist level were used in a restricted sample analysis that included endoscopists and facilities with between 5% and 95% propofol sedation use. RESULTS: A total of 54,063 colonoscopies were analyzed in the full sample and 18,998 in the restricted sample. Serrated polyp prevalence was significantly higher using propofol (9,957 of 29,312; 34.0% [95% CI, 33.4 to 34.5%]) versus moderate sedation (6,066 of 24,751; 24.5% [95% CI, 24.0 to 25.1%]) in the full sample and restricted...