Brief Article
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World J Gastroenterol. Sep 14, 2011; 17(34): 3912-3915
Published online Sep 14, 2011. doi: 10.3748/wjg.v17.i34.3912
Conscious or unconscious: The impact of sedation choice on colon adenoma detection
Mark Metwally, Nicholas Agresti, William B Hale, Victor Ciofoaia, Ryan O'Connor, Michael B Wallace, Jonathan Fine, Yun Wang, Seth A Gross
Mark Metwally, Nicholas Agresti, William B Hale, Victor Ciofoaia, Jonathan Fine, Seth A Gross, Ryan O’Connor, Department of Gastroenterology, Norwalk Hospital, 34 Stevens St. Norwalk, CT 06850, United States
Michael B Wallace, Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road, FL 32224, United States
Yun Wang, Department of Statistics, Yale University, 333 Cedar Street, New Haven, CT 06510, USA 34 Stevens St. Norwalk, CT 06850, United States
Author contributions: Metwally M, Gross SA, Hale WB and Agresti N designed the research; Metwally M, Agresti N, Ciofoaia V and O’Connor R collected data; Metwally M, Hale WB, Gross SA, Wang Y and Wallace MB analyzed data; Metwally M, Hale WB, Fine J and Gross SA wrote the paper.
Correspondence to: Mark Metwally, MD, Department of Gas-troenterology, Norwalk Hospital, 34 Stevens St. Norwalk, CT 06850, United States. mark.metwally@gmail.com
Telephone: +1-203-249-1416 Fax: +1-203-855-3589
Received: January 20, 2011
Revised: March 29, 2011
Accepted: April 5, 2011
Published online: September 14, 2011
Abstract

AIM: To determine if anesthesiologist-monitored use of propofol results in improved detection of adenomas when compared with routine conscious sedation.

METHODS: This retrospective study was conducted at two separate hospital-based endoscopy units where approximately 12 000 endoscopic procedures are performed annually, with one endoscopy unit exclusively using anesthesiologist-monitored propofol. Three thousand two hundred and fifty-two patients underwent initial screening or surveillance colonoscopies. Our primary end point was the adenoma detection rate, defined as the number of patients in whom at least one adenoma was found, associated with the type of sedation.

RESULTS: Three thousand two hundred and fifty-two outpatient colonoscopies were performed by five selected endoscopists. At least one adenoma was detected in 27.6% of patients (95% CI = 26.0-29.1) with no difference in the detection rate between the anesthesiologist -propofol and group and the gastroenterologist-midazolam/fentanyl group (28.1% vs 27.1%, P = 0.53).

CONCLUSION: The type of sedation used during co-lonoscopy does not affect the number of patients in whom adenomatous polyps are detected.

Keywords: Sedation; Colonoscopy; Adenoma