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.
- Screening colonoscopy to reduce colorectal cancer incidence and mortality remains an important public health strategy.
- Adenomas and serrated polyps constitute the two major precursors of colorectal cancer, with serrated polyps being more difficult to detect during screening colonoscopy. Prevention is accomplished by removing polyps before they can become cancer.
- Between 2015 and 2020, the New Hampshire Colonoscopy registry included 54,063 colonoscopies after exclusions with detailed patient, procedure, endoscopist, sedation, and pathology data elements.
- Among 18,998 colonoscopies performed at the subset of facilities that routinely used both sedation options, serrated polyps were detected more often among patients receiving propofol sedation (30.3%; 1,410 of 4,661) versus moderate sedation (25.7%; 3,690 of 14,337).
- After adjustment for patient and endoscopist factors at these facilities, propofol sedation was associated with a 13% higher likelihood of detecting serrated polyps compared to moderate sedation. No difference in the likelihood of detecting adenomas was observed.
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