Su1056 PROPOFOL VERSUS MIDAZOLAM SEDATION FOR ELECTIVE ENDOSCOPY IN PATIENTS WITH CIRRHOSIS. A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

Patients with cirrhosis frequently require sedation for elective endoscopic procedures. Several sedation protocols are available, but choosing an appropriate sedative in patients with cirrhosis is challenging. We aimed to conduct a systematic review and meta-analysis of available literature to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best approach. This systematic review and meta-analysis was performed using PRISMA guidelines and was registered in PROSPERO. Electronic searches using MEDLINE, EMBASE, Central Cochrane, Latin-American, and Caribbean Health Sciences Literature (LILACS) databases, as well as the gray literature searches, were performed. Only randomized control trials (RCTs) comparing midazolam and propofol sedation for elective endoscopy in patients with cirrhosis were included. The primary outcomes of interest were procedure time, recovery time, time to discharge, and adverse events, including bradycardia, hypotension, and hypoxemia. The risk of bias assessment was performed using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB-2). Quality of evidence was evaluated by GRADEpro. Meta-analysis was performed using Review Manager. The search yielded 3,576 records. Out of these, 8 RCTs with a total of 596 patients (302 in the Propofol group and 294 in the Midazolam group) were included for the final analysis. The procedure time was similar between midazolam and propofol groups (Mean Difference (MD) 0.25 (95%CI -0.64 - 1.13), p-value <0.59). The recovery time was significantly less in the propofol group as compared to the midazolam group (MD -8.19 (95%CI -10.59 - -5.79), p-value < 0.00001) (Figure 1). Similarly, the time to discharge was significantly less in the propofol group (MD -12.98 (95%CI -18.46 - -6.50), p-value <0.00001) (Figure 2). Adverse events were similar in both the groups (Risk Difference (RD) 0.02 (95%CI 0 - 0.04), p-value 0.58). Moreover, no significant difference was found for each individual adverse event (bradycardia RD 0.03 (95%CI -0.01 - 0.07), p-value 0.16; hypotension RD 0.03 (95% CI -0.01 - 0.07), p-value 0.17 and hypoxemia RD 0.00 (95%CI -0.04 - 0.04), p-value 0.93). The risk of bias was low for five studies, while two studies showed some concerns, and one study was high risk. The quality of evidence was very low for procedure time, recovery time, and adverse events and low for discharge time. This systematic review and meta-analysis based on randomized controlled trials show that propofol has shorter recovery and patient discharge time as compared to midazolam. However, there is no difference in adverse events.