Safety of Propofol in Cirrhotic Patients Undergoing Upper Endoscopy (EGD): A Systematic Review and Meta-Analysis

Abstract

Introduction: EGD is recommended for patients with cirrhosis for screening and surveillance of varices. Underlying encephalopathy and decreased liver clearance may cause cardiopulmonary adverse events and worsening of hepatic encephalopathy in cirrhotic patients undergoing procedural sedation. With increasing use of Propofol for endoscopic procedures, it is important to assess its safety in these patients. Our aim was to examine available studies to derive pooled rates for the safety and efficacy of Propofol in cirrhotic patients undergoing EGD. Methods: Electronic database search was conducted in Medline, Embase, Cochrane for eligible studies that compared safety profile of Propofol between cirrhotics and controls (no cirrhosis). Following outcomes were examined to evaluate the safety profile of propofol: cardiopulmonary adverse events, procedure time, time to recovery, dosage, and number connection test (NCT) to assess cognitive impairment. Pooled rates of variables were reported as Odds ratio (OR) with 95% confidence interval and heterogeneity was reported as I2 statistics. Results: A total of 7 studies were found eligible and analysis with a total of 723 patients. (cirrhosis: 509 and control: 215). Rate of adverse events related to cardiopulmonary system were numerically higher in patients with cirrhosis (15.5% vs 12.09%), however, this was not statistically significant (pooled OR 1.06, 95% CI: 0.65-1.74, p 0.44). There was no significant difference in procedure time in cirrhotics compared to controls (mean weighted difference 1.76 minutes, 95% CI -1.81 to 5.34, p 0.33). Mean NCT score before and after procedure in the cirrhosis group was 82.93 seconds and 76.66 seconds, respectively (p=0.003). Weighted mean difference in NCT scores between the cirrhotic and control group before and after procedure was 49.27 seconds and 43.68 seconds, respectively suggesting no significant change in NCT scores in patients with cirrhosis. Mean dosage of Propofol in cirrhotics compared to controls was 99.26mg to 100.28mg (p=0.97). There was no significant difference in recovery time between two groups (mean weighted difference 0.10 minutes, 95% CI: -0.91 to 1.12, p 0.84). Conclusion: This meta-analysis suggests that Propofol does not adversely affect cognitive scores or recovery time in cirrhosis compared to controls when used for EGD. The cardiopulmonary side effects were also similar in both groups. Therefore propofol can be used safely for procedural sedation in patients with cirrhosis undergoing EGD.Figure: CARDIOPULMONARY COMPLICATIONS.Figure: RECOVERY TIME.Figure: PROCEDURE TIME.