Does deep sedation with propofol affect adenoma detection rates in average risk screening colonoscopy exams?
Does deep sedation with propofol affect adenoma detection rates in average risk screening colonoscopy exams?
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DOI：
10.4253/wjge.v9.i4.177
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发表时间：
2017-04-16
影响因子：
2
通讯作者：
Ross WA
中科院分区：
文献类型：
--
作者：
Thirumurthi S;Raju GS;Pande M;Ruiz J;Carlson R;Hagan KB;Lee JH;Ross WA
旨在确定与中度镇静相比，丙泊酚镇静对平均风险筛查结肠镜检查中腺瘤检出率 (ADR) 和盲肠插管率 (CIR) 的影响。我们对 2010 年至 2013 年在 MD 安德森癌症中心进行的 2604 例首次平均风险筛查结肠镜检查进行了回顾性图表审查。计算每个镇静组的 ADR 和 CIR。进行多变量回归分析以调整年龄和体重指数（BMI）的潜在混杂因素。三分之一的检查是使用异丙酚完成的（n = 874）。异丙酚组的总体 ADR 显着高于中度镇静组（46.3% vs 41.2%，P = 0.01）。调整年龄和体重指数差异后，两组之间的 ADR 相似。所有考试的 CIR 均为 99%。异丙酚患者的平均盲肠插入时间较短（6.9 分钟 vs 8.2 分钟；P < 0.0001）。在我们的平均风险患者群体中，使用异丙酚深度镇静进行结肠镜检查并没有显着改善 ADR 或 CIR。虽然异丙酚可能对某些患者（例如患有睡眠呼吸暂停的患者）提供更安全的镇静作用，但对结肠镜检查质量指标的总体影响并不显着。鉴于其成本增加，应谨慎使用异丙酚，并且不要隐含期望进行更高质量的筛查检查。
To determine the effect of sedation with propofol on adenoma detection rate (ADR) and cecal intubation rates (CIR) in average risk screening colonoscopies compared to moderate sedation. We conducted a retrospective chart review of 2604 first-time average risk screening colonoscopies performed at MD Anderson Cancer Center from 2010-2013. ADR and CIR were calculated in each sedation group. Multivariable regression analysis was performed to adjust for potential confounders of age and body mass index (BMI). One-third of the exams were done with propofol (n = 874). Overall ADR in the propofol group was significantly higher than moderate sedation (46.3% vs 41.2%, P = 0.01). After adjustment for age and BMI differences, ADR was similar between the groups. CIR was 99% for all exams. The mean cecal insertion time was shorter among propofol patients (6.9 min vs 8.2 min; P < 0.0001). Deep sedation with propofol for screening colonoscopy did not significantly improve ADR or CIR in our population of average risk patients. While propofol may allow for safer sedation in certain patients (e.g., with sleep apnea), the overall effect on colonoscopy quality metrics is not significant. Given its increased cost, propofol should be used judiciously and without the implicit expectation of a higher quality screening exam.