Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, Maine; Division of Anesthesiology, Spectrum Healthcare Partners, South Portland, Maine; Assistant Professor of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts.
Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; New Hampshire Colonoscopy Registry, Lebanon, New Hampshire.
Anesthesiology. 2024 Jun 1;140(6):1088-1097. doi: 10.1097/ALN.0000000000004955.
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.
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.
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 samples (1,410 of 4,661; 30.3% [95% CI, 28.9 to 31.6%] vs. 3,690 of 14,337; 25.7% [95% CI, 25.0 to 26.5%]). In the full sample multivariate logistic regression, propofol was associated with higher neoplasm (adjusted odds ratio, 1.25 [95% CI, 1.21 to 1.29]), adenoma (odds ratio, 1.07 [95% CI, 1.03 to 1.11]), and serrated polyp detection (odds ratio, 1.51 [95% CI, 1.46 to 1.57]). In the restricted sample using inverse probability of treatment weighted propensity score adjustment and clustering at the endoscopist level, an attenuated but statistically significant effect size was observed for serrated polyps (odds ratio, 1.13 [95% CI, 1.07 to 1.19]), but not for adenomas (odds ratio, 1.00 [95% CI, 0.95 to 1.05]) or any neoplastic lesion (odds ratio, 1.03 [95% CI, 0.98 to 1.08]).
Propofol sedation during colonoscopy may be associated with improved detection of serrated polyps, but not adenomas.
结直肠癌是癌症相关死亡的主要原因。腺瘤和锯齿状息肉是结直肠癌的前体，锯齿状息肉在结肠镜检查中更难检测到。使用异丙酚与息肉检测之间的关系仍不清楚。作者研究了在结肠镜检查中使用异丙酚与轻度中度镇静对腺瘤和锯齿状息肉检测的关联。
本回顾性队列研究使用了新罕布什尔州结肠镜检查登记处的观察数据。纳入了年龄大于 50 岁的患者，他们在 2015 年 1 月 1 日至 2020 年 2 月 28 日期间进行了筛查或监测结肠镜检查。排除诊断性检查、无镇静、缺失病理数据和肠道准备不佳的患者。多变量逻辑回归用于评估全样本中异丙酚与中度镇静之间在调整协变量后在息肉检测方面的差异。在包括使用异丙酚镇静 5%至 95%的内镜医生和医疗机构的受限样本分析中，使用倾向评分调整和内镜医生水平聚类。
全样本分析共分析了 54063 例结肠镜检查，限制样本分析共分析了 18998 例结肠镜检查。在全样本和限制样本中，使用异丙酚时锯齿状息肉的患病率明显更高（29312 例中的 9957 例；34.0%[95%CI，33.4%至 34.5%]），而使用中度镇静时为 6066 例（24751 例；24.5%[95%CI，24.0%至 25.1%]）。在全样本和受限样本中，异丙酚与更高的肿瘤（调整后的优势比，1.25[95%CI，1.21 至 1.29]）、腺瘤（优势比，1.07[95%CI，1.03 至 1.11]）和锯齿状息肉检测（优势比，1.51[95%CI，1.46 至 1.57]）相关。在受限样本中，使用逆概率治疗加权倾向评分调整和内镜医生水平聚类后，锯齿状息肉的效应大小虽有所减弱但仍具有统计学意义（优势比，1.13[95%CI，1.07 至 1.19]），但腺瘤（优势比，1.00[95%CI，0.95 至 1.05]）或任何肿瘤病变（优势比，1.03[95%CI，0.98 至 1.08]）则没有。
结肠镜检查中使用异丙酚镇静可能与锯齿状息肉的检测改善有关，但与腺瘤无关。
