Published online Aug 16, 2020. doi: 10.4253/wjge.v12.i8.241
Peer-review started: March 31, 2020
First decision: June 7, 2020
Revised: June 12, 2020
Accepted: July 18, 2020
Article in press: July 18, 2020
Published online: August 16, 2020
Processing time: 135 Days and 3.6 Hours
Administration of analgesics and intravenous sedation during endoscopy in patients with cirrhosis has several advantages such as patient comfort, reduced discharge time, and early recovery after the procedure. However, proper selection of sedative medications is essential because of the risk of complications mainly due to underlying hepatic dysfunction– which can lead to difficulty in clearance, recirculation, and increased half-life of drugs.
Many diagnostic or therapeutic upper gastrointestinal endoscopy procedures are often performed in cirrhosis, but choosing effective and safe sedative medications can be a real challenge. Therefore, we wanted to compare commonly used sedation protocols in an attempt to understand the best approach.
To perform a systematic review and meta-analysis of Randomized Controlled Trials comparing sedation with propofol and midazolam in patients with cirrhosis undergoing elective endoscopy.
We performed a systematic review and meta-analysis using the PRISMA guidelines. Electronic searches were performed using MEDLINE, EMBASE, Central Cochrane, LILACS databases. Only randomized control trials (RCTs) were included. The outcomes studied were procedure time, recovery time, discharge time, and adverse events (bradycardia, hypotension, and hypoxemia).
Eight randomized clinical trials were included in the final analysis with a total of 596 patients, of whom 302 belonged to the propofol group and 294 to the midazolam group. Procedure time was similar between midazolam and propofol groups; however, the recovery time and discharge time were significantly less in the propofol group. Adverse events were similar in both groups, and no significant difference was found in rates of bradycardia, hypotension, and hypoxemia.
Our study showed that propofol has shorter recovery and patient discharge time as compared to midazolam with a similar rate of adverse events. These results suggest that propofol should be the preferred agent for sedation in patients with cirrhosis.
Sedation medications used during endoscopy can differ in outcomes in patients with cirrhosis. Randomized control trials comparing outcomes and adverse events of multiple sedation protocols in patients with cirrhosis should be carried out in the future.