Copyright
©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of sedation on adenoma and polyp detection rates and cecal intubation in elderly patients undergoing screening colonoscopy
Vedran Tomasic, Petra Ćaćić, Irma Siranovic Pongrac, Stipe Pelajić, Neven Barsic, Andrea Arefijev, Ivan Lerotic, Ante Blazevic, Alen Bišćanin
Vedran Tomasic, Division of Endoscopy and Day Hospital, Department of Internal Medicine, University Hospital Centre “Sestre Milosrdnice”, Zagreb 10000, Croatia
Vedran Tomasic, Ivan Lerotic, Department of Internal Medicine, Catholic University of Croatia School of Medicine, Zagreb 10000, Croatia
Petra Ćaćić, Irma Siranovic Pongrac, Stipe Pelajić, Neven Barsic, Ivan Lerotic, Alen Bišćanin, Division of Gastroenterology, Department of Internal Medicine, University Hospital Center “Sestre Milosrdnice”, Zagreb 10000, Croatia
Neven Barsic, Alen Bišćanin, Department of Internal Medicine, University of Zagreb School of Medicine, Zagreb 10000, Croatia
Andrea Arefijev, Department of Internal Medicine, Pula General Hospital, Pula 52100, Istarska Zupanija, Croatia
Ante Blazevic, Department of Thoracic Surgery, University Hospital Dubrava, Zagreb 10000, Croatia
Author contributions: Tomasic V and Barsic N designed the study; Tomasic V, Siranovic Pongrac I, Ćaćić P, and Pelajić S were responsible for developing the methodology; Ćaćić P, Siranović Pongrac I, Arefijev A, Pelajić S, and Blazevic A participated in formal analysis and investigation; Tomasic V and Ćaćić P wrote the original draft; Tomasic V, Ćaćić P, Barsic N, Lerotic I, and Bišćanin A participated in manuscript review and editing.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Sestre Milosrdnice University Hospital Center, Zagreb, Croatia (approval No. 251-29-11/3-25-11).
Informed consent statement: Owing to the retrospective nature of the study, which involved physicians reviewing patient records they had authored and to which they had authorized access, additional informed consent was not required.
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 additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Vedran Tomasic, MD, PhD, Assistant Professor, Consultant, Division of Endoscopy and Day Hospital, Department of Internal Medicine, University Hospital Centre “Sestre Milosrdnice”, Vinogradska Cesta 29, Zagreb 10000, Croatia.
tomasicvedran@gmail.com
Received: August 6, 2025
Revised: October 23, 2025
Accepted: January 4, 2026
Published online: March 5, 2026
Processing time: 189 Days and 6.3 Hours
BACKGROUND
Increasing age is a major risk factor for colorectal neoplasia, with older adults showing a higher incidence of adenomas compared to individuals under 60 years. Early detection of colonic adenomas and polyps significantly reduces the risk of colorectal cancer. Key quality indicators for colonoscopy include the adenoma detection rate (ADR), polyp detection rate (PDR), and cecal intubation rate (CIR). However, studies comparing these metrics in elderly patients deeply sedated with propofol vs those undergoing colonoscopy without sedation show mixed results.
AIM
To evaluate deep propofol sedation vs no sedation impact on ADR, PDR, and CIR in elderly patients undergoing screening colonoscopy.
METHODS
This retrospective cohort study included adults over 60 years who underwent their first screening colonoscopy between January 2017 and September 2023. Exclusion criteria were emergency procedures, inflammatory bowel disease, procedures performed for therapeutic intent, and inadequate bowel preparation [Boston Bowel Preparation Scale (BBPS) score below 6]. Normality was tested by the Kolmogorov-Smirnov test; continuous variables were compared by the Mann-Whitney U test, categorical variables using the χ2 or Fisher’s exact test. Binary logistic regression identified significant outcome predictors.
RESULTS
A total of 2034 patients (46.4% female; mean age: 70 years) were included, of whom 622 (30.6%) underwent colonoscopy under deep sedation. The overall PDR was 51.65%, ADR was 33.3%, and CIR was 94.25%. After adjusting for confounders [age, sex, body mass index (BMI), BBPS, operation, and diverticulosis], no significant differences were observed in PDR (51.8% vs 51.5%), ADR (33.5% vs 32.5%), or CIR (93.2% vs 95.3%) between the no-sedation and deep-sedation groups. Higher BMI (B = 0.96, P < 0.01) and male sex (B = 0.64, P < 0.01) were independent predictors of higher ADR.
CONCLUSION
In this elderly cohort, propofol-induced deep sedation did not significantly improve ADR, PDR, or CIR. Further research is warranted to clarify its effect on colonoscopy quality metrics in older populations.
Core Tip: Increasing life expectancy and population aging have increased the incidence of colorectal adenomas and cancers, especially among elderly individuals with obesity. Individual health assessments are crucial, as strict age-based decision-making alone is insufficient. Physicians need to prioritize both patient comfort and procedural safety when considering sedation. Although sedation may not boost overall detection and completion rates, it may be beneficial for obese, male, and late-elderly patients. Effective bowel preparation is the key factor influencing colonoscopy completion in the elderly. Therefore, providing additional guidance and support on bowel preparation is essential for obese elderly men to improve colonoscopy outcomes.
