Does Type of Sedation Affect Cecal Intubation and Polyp Detection Rates?

Abstract

Background: Cecal intubation is one of the goals of colonoscopy; it is also considered to be one of the performance indicators. Propofol, fentanyl and midazolam are commonly being used for sedation in colonoscopy. Whether sedation type can influence colonoscopy outcomes (i.e. cecal intubation, polyp detection rate) is unclear. Aim: To compare cecal intubation and polyp detection rates in patients receiving propofol and midazolam/fentanyl combination. Methods: We retrospectively reviewed 5,863 consecutive colonoscopies performed on adults by six full-time gastroenterologists between 2004 and 2007 in an urban hospital. For each colonoscopy, type of sedation, extent of the exam, polyp findings, patient's age, sex, inpatient or outpatient status, quality of bowel preparation, using Aronchick scale (excellent = 5, good = 4, fair = 3, poor = 2, inadequate = 1.), were noted and analyzed using Student t-test and Fischer's exact tests as indicated. P < 0.05 was considered significant. Results: 60% of all colonoscopies utilized propofol. Overall cecal intubation rate was 93%. Overall cecal intubation rates with propofol and midazolam/fentanyl were 95% and 90% respectively, P = 0.0001. Propofol was used more in outpatients (62%) compared to inpatients (54%), P = 0.0002. Further analysis showed that in outpatient population (n = 5148) cecal intubation rates with propofol and midazolam/fentanyl were 97% and 92% respectively, P = 0.0001. This population was largely females (63%). There was a trend for propofol use in females (64%) compared to males (36%), P = 0.0259. Mean age was the same in both sedation groups (59), P = 1.0. Both sedation groups had equal bowel preparation score (median = 4) on Aronchick scale. Polyp detection rates was similar in the two sedation groups, 44% vs. 43%, P = 0.9290. In the inpatient population (n = 715) cecal intubation rates with propofol and midazolam/fentanyl were 79% and 78% respectively, P = 0.8549. There was no statistical single sex predominance in this population as a whole, or in the two sedation groups, P = 0.3918. There was no age difference between the two sedation groups, 69 vs. 67, P = 0.0961. Both groups had equal bowel preparation score (median = 3) on Aronchick scale. Polyp detection rates were similar in both sedation groups, 28% vs. 31%, P = 0.4564. Conclusion: Our study suggests that propofol sedation could be associated with higher cecal intubation rates in an outpatient population. It appears that the type of sedation had insignificant effect on cecal intubation rate in the inpatients. Cecal intubation rates were lower in inpatients. Polyp detection rates were similar in propofol and midazolam/versed groups in inpatient and outpatient populations.