Ott C, Dobsch P, Sander M, Schnoy E, Pawlik MT. Moderate sedation with midazolam and propofol is as safe as propofol monotherapy for colonoscopy, but more cost-effective. World J Gastrointest Endosc 2026; 18(4): 118261 [DOI: 10.4253/wjge.v18.i4.118261]
Corresponding Author of This Article
Claudia Ott, MD, PhD, Internal Medicine and Gastroenterology, Gastroenterology at FAZ, Hildegard-von-Bingen-Str. 1, Regensburg 93053, Bavaria, Germany. claudiaott4@t-online.de
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Gastroenterology & Hepatology
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Retrospective Cohort Study
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Apr 16, 2026 (publication date) through Apr 16, 2026
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Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Ott C, Dobsch P, Sander M, Schnoy E, Pawlik MT. Moderate sedation with midazolam and propofol is as safe as propofol monotherapy for colonoscopy, but more cost-effective. World J Gastrointest Endosc 2026; 18(4): 118261 [DOI: 10.4253/wjge.v18.i4.118261]
World J Gastrointest Endosc. Apr 16, 2026; 18(4): 118261 Published online Apr 16, 2026. doi: 10.4253/wjge.v18.i4.118261
Moderate sedation with midazolam and propofol is as safe as propofol monotherapy for colonoscopy, but more cost-effective
Claudia Ott, Philipp Dobsch, Markus Sander, Elisabeth Schnoy, Michael T Pawlik
Claudia Ott, Philipp Dobsch, Markus Sander, Internal Medicine and Gastroenterology, Gastroenterology at FAZ, Regensburg 93053, Bavaria, Germany
Elisabeth Schnoy, Medical Clinic III, University of Augsburg, Augsburg 86156, Bavaria, Germany
Michael T Pawlik, Department of Anesthesiology and Intensive Care Medicine, Caritas Hospital St. Josef, Regensburg 93053, Bavaria, Germany
Author contributions: Ott C designed the study; Ott C and Pawlik MT were responsible for developing the methodology; Dobsch P and Sander M participated in the formal analysis and investigation; Ott C wrote the original draft; Dobsch P, Sander M, Schnoy E and Pawlik MT participated in the review and editing.
Institutional review board statement: A vote was obtained and approved by the Regensburg Ethics Committee under No. 25-4430-104.
Informed consent statement: All patients gave informed consent in data storage and analysis.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: No data sharing.
Corresponding author: Claudia Ott, MD, PhD, Internal Medicine and Gastroenterology, Gastroenterology at FAZ, Hildegard-von-Bingen-Str. 1, Regensburg 93053, Bavaria, Germany. claudiaott4@t-online.de
Received: December 29, 2025 Revised: February 5, 2026 Accepted: March 13, 2026 Published online: April 16, 2026 Processing time: 106 Days and 15.3 Hours
Abstract
BACKGROUND
Moderate sedation can significantly increase the acceptance of preventive colonoscopy, with different sedation regimens being used.
AIM
To compare sedation with low-dose midazolam in combination with propofol combination therapy (PCT) with sedation with propofol monotherapy (PMT) during preventive colonoscopy.
METHODS
Retrospective analysis of a total of 120 patients who were sedated with either PCT or PMT. The propofol dose administered, complications such as hypotension or hypoxia, examination time and time to discharge were evaluated. In addition, the costs of the respective sedations were calculated.
RESULTS
The propofol dose administered was significantly higher in the PMT group than in the PCT group (217 mg vs 65 mg, P < 0.01), the examination time was significantly shorter in the PMT group (18.6 minutes vs 21.4 minutes, P = 0.02) and the time to discharge was significantly shorter in the PCT group (49.4 minutes vs 57.7 minutes, P = 0.04). No patient experienced a sedation-related complication requiring treatment. The costs of sedation in the PCT group were significantly lower than those in the PMT group.
CONCLUSION
Sedation with midazolam in combination with propofol is as safe for performing outpatient preventive colonoscopy as monotherapy with propofol. Combination therapy may potentially reduce costs.
Core Tip: Various guideline recommendations for sedation in gastroenterological endoscopy exist, but there is little data available on the use of combination therapy with low-dose midazolam in combination with propofol vs propofol monotherapy (PMT) for short-term outpatient procedures in patients with a low examination risk. This cohort study analysed the safety and costs of a combination therapy with low-dose midazolam in combination with propofol vs PMT in 120 patients undergoing preventive colonoscopy. Combination therapy was as safe as PMT, but was less expensive.
