Impact of sedation on adenoma and polyp detection rates and cecal intubation in elderly patients undergoing screening colonoscopy

Table 1 Patients’ characteristics and outcomes according to sedation and no sedation groups, n (%)

Variable	Sedation, n = 622	No sedation, n = 1412	P value
Age in years	68 (64-73)	70 (65-76)	< 0.01a
Female sex	359 (57.7)	655 (46.4)	< 0.01b
BMI kg/m2	27.1 (23.7-29.9)	27 (24.3-30.5)	0.25
BBPS	9 (6-9)	8 (6-9)	0.15
PDR	320 (51.5)	731 (51.8)	0.92
ADR	202 (32.5)	472 (33.5)	0.68
CIR	593 (95.3)	1316 (93.2)	0.07
Intubation of terminal ileum	342 (55.1)	680 (48.2)	< 0.01a
Previous operation	186 (29.9)	488 (34.6)	0.04
Diverticulosis	272 (43.8)	523 (37.1)	< 0.01c

^aP < 0.05 vs sedation-free group.

^bP < 0.05 vs male sex.

^cP < 0.05 vs group without diverticulosis.

Data are presented as mean (range) or n (%). Age U = 368204, Z = -5.8; sex χ² (1, n = 2034) = 2217; body mass index U = 58113, Z = -1.1; BBPS U = 404391.5; z = -1.4; polyp detection rate: χ² (1, n = 2033) = 0.01; adenoma detection rate: χ² (1, n = 2031) = 0.17; cecal intubation rate: χ² (1, n = 2034) = 3.41; terminal ileum intubation χ² (1, n = 2032) = 8.16; previous operationχ² (1, n = 2034) = 4.4; diverticulosis χ² (1, n = 2031) = 8.14. ADR: Adenoma detection rate; BBPS: Boston bowel preparation scale; BMI: Body mass index; CIR: Cecal intubation rate; PDR: Polyp detection rate.

Table 2 Univariable logistic regression analysis of risk factors for polyp detection rate, n (%)

Variable	OR (95%CI)	P value
Age	1.01 (1-1.02)	0.29
Female sex	0.68 (0.57-0.81)	< 0.01a
BMI	1.07 (1.03-1.1)	< 0.01b
BBPS	1.04 (0.99-1.1)	0.1
Previous operation	1.14 (0.94-1.38)	0.18
Diverticulosis	0.93 (0.77-1.11)	0.41
Sedation	0.97 (0.8-1.18)	0.79

^aP < 0.05 vs male sex.

^bP < 0.05 vs body mass index < 25 kg/m².

CI: Confidence interval; BBPS: Boston Bowel preparation scale; BMI: Body mass index; OR: Odds ratio.

Table 3 Univariable logistic regression analysis of risk factors for adenoma detection rate

Variable	OR (95%CI)	P value
Age	0.99 (0.98-1.01)	0.77
Female sex	0.7 (0.58-0.85)	< 0.01a
BMI	1.04 (1.01-1.07)	< 0.01b
BBPS	1.04 (0.97-1.09)	0.33
Previous operation	1.06 (0.87-1.3)	0.56
Diverticulosis	0.88 (0.71-1.05)	0.15
Sedation	0.95 (0.77-1.16)	0.61

^aP < 0.05 vs male sex.

^bP < 0.05 vs group with body mass index < 25 kg/m².

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; OR: Odds ratio.

Table 4 Univariable logistic regression analysis of risk factors for cecal intubation rate

Variables	OR (95%CI)	P value
Age	0.95 (0.93-0.97)	< 0.01a
Female sex	0.69 (0.48-0.99)	0.05
BMI	1.03 (0.98-1.08)	0.24
BBPS	1.91 (1.75-2.09)	< 0.01b
Previous operation	0.73 (0.50-1.06)	0.09
Diverticulosis	1.84 (1.22-2.76)	< 0.01c
Sedation	1.49 (0.97-2.29)	0.06

^aP < 0.05 vs older age.

^bP < 0.05 vs lower Boston bowel preparation scale.

^cP < 0.05 vs group without diverticulosis.

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; OR: Odds ratio.

Table 5 Multivariable logistic regression for polyp detection rate as the dependent variable

Variable	B	S.E.	Wald	df	Sig.	Exp(B)	95%CI lower-upper
Sex (1)	-0.214	0.162	1.733	1	0.188	0.807	0.587-1.11
Age	0.012	0.012	1.025	1	0.311	1.012	0.989-1.035
Sedation (1)	0.183	0.179	1.054	1	0.305	1.201	0.846-1.705
BBPS	-0.006	0.045	0.016	1	0.9	0.994	0.911-1.085
Diverticulosis (1)	-0.161	0.169	0.911	1	0.34	0.851	0.612-1.185
Operations (1)	0.15	0.164	0.83	1	0.362	1.161	0.842-1.602
BMI	0.062	0.015	16.005	1	0a	1.064	1.032-1.096
Constant	-1.88	1.018	3.409	1	0.065	0.153

^aP < 0.005 vs group with body mass index < 25 kg/m².

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; df: Degrees of freedom; PDR: Polyp detection rate.

Table 6 Multivariable logistic regression for adenoma detection rate as the dependent variable

Variable	B	S.E.	Wald	df	Sig.	Exp(B)	95%CI lower-upper
Sex (1)	-0.366	0.158	5.354	1	0.021a	0.694	0.509-0.946
Age	0.006	0.011	0.286	1	0.593	1.006	0.984-1.028
Sedation (1)	-0.041	0.173	0.056	1	0.814	0.96	0.683-1.349
BBPS	-0.01	0.043	0.053	1	0.819	0.99	0.91-1.077
Diverticulosis (1)	-0.334	0.165	4.084	1	0.043b	0.716	0.518-0.99
Operations (1)	0.105	0.159	0.433	1	0.51	1.11	0.813-1.516
BMI	0.039	0.015	7.024	1	0.008c	1.04	1.01-1.07
Constant	-1.43	0.989	2.092	1	0.148	0.239

^aP < 0.05 vs female sex.

^bP < 0.05 vs group without diverticulosis.

^cP < 0.05 vs group with body mass index < 25 kg/m².

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; df: Degrees of freedom.

Table 7 Multivariable logistic regression for cecal intubation rate as the dependent variable

Variable	B	S.E.	Wald	df	Sig.	Exp(B)	95%CI for Exp(B)
Sex	-0.450	0.159	7.956	1	0.005a	0.638	0.467-0.872
Age	-0.012	0.011	1.221	1	0.269	0.988	0.966-1.010
Sedation	0.219	0.173	1.596	1	0.206	1.245	0.886-1.748
BBPS	0.346	0.045	59.857	1	0.000b	1.414	1.295-1.543
Diverticulosis	0.238	0.166	2.064	1	0.151	1.268	0.917-1.754
Operation	-0.129	0.160	0.647	1	0.421	0.879	0.642-1.204
BMI	-0.040	0.015	7.116	1	0.008c	0.961	0.934-0.990
Constant	-0.541	0.993	0.297	1	0.586	0.582	-

^aP < 0.05 vs female sex.

^bP < 0.05 vs group with lower BBPS.

^cP < 0.05 vs group with body mass index < 25 kg/m².

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; CIR: Cecal intubation rate; df: Degrees of freedom.

Table 8 Adjusted odds ratios for sedation in relation to key endoscopic outcomes

Variable	OR (95%CI)	P value
PDR	1.2 (0.85-1.71)	0.31
ADR	0.96 (0.68-1.35)	0.81
CIR	1.25 (0.89-1.75)	0.21

CI: Confidence interval; ADR: Adenoma detection rate; CIR: Cecal intubation rate; OR: Odds ratio; PDR: Polyp detection rate.

Table 9 Adjusted odds ratios for sedation in different age subgroups

Variable	Age group 60-74 years		Age group ≥ 75 years
	OR (95%CI)	P value	OR (95%CI)	P value
PDR	1.23 (0.81-1.88)	0.32	1.05 (0.55-2.01)	0.88
ADR	1.22 (0.81-1.83)	0.35	0.52 (0.28-0.99)	0.05
CIR	0.79 (0.18-3.56)	0.76	0.77 (0.18-3.42)	0.74

ADR: Adenoma detection rate; CI: Confidence interval; CIR: Cecal intubation rate; OR: Odds ratio; PDR: Polyp detection rate.

Table 10 Multivariable logistic regression for polyp detection rate in the age group 60-74 years

Variable	B	S.E.	Wald	df	Sig.	Exp(B)	95%CI for Exp(B) (lower-upper)
Sex (1)	-0.285	0.198	2.060	1	0.151	0.752	0.510-1.110
Age	0.019	0.024	0.634	1	0.426	1.019	0.973-1.068
Sedation (1)	0.214	0.214	1.002	1	0.317	1.239	0.815- 1.884
BBPS	-0.059	0.057	1.076	1	0.300	0.943	0.844-1.054
Diverticulosis (1)	-0.092	0.210	0.191	1	0.662	0.912	0.605-1.376
Operations (1)	0.149	0.201	0.549	1	0.459	1.161	0.782-1.722
BMI	0.052	0.017	9.612	1	0.002a	1.053	1.019-1.089

^aP < 0.05 vs group with body mass index < 25 kg/m².

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; df: Degrees of freedom.

Table 11 Multivariable logistic regression analysis for polyp detection rate in the age group ≥ 75 years

Variable	B	S.E.	Wald	df	Sig.	Exp(B)	95%CI for Exp(B) (lower-upper)
Sex (1)	0.031	0.295	0.011	1	0.916	1.032	0.579-1.839
Age	-0.023	0.038	0.351	1	0.553	0.978	0.907-1.054
Sedation (1)	0.049	0.331	0.022	1	0.882	1.051	0.549-2.011
BBPS	0.089	0.075	1.402	1	0.236	1.093	0.943-1.266
Diverticulosis (1)	-0.266	0.298	0.797	1	0.372	0.766	0.427-1.374
Operations (1)	0.123	0.296	0.174	1	0.677	1.131	0.633-2.020
BMI	0.107	0.038	8.016	1	0.005a	1.113	1.033-1.198

^aP < 0.05 vs group with body mass index < 25 kg/m².

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; df: Degrees of freedom.

Table 12 Multivariable logistic regression analysis for adenoma detection rate in the age group 60-74 years

Variable	B	S.E.	Wald	df	Sig.	Exp(B)	95%CI for Exp(B) (lower-upper)
Sex (1)	-0.498	0.196	6.441	1	0.011a	0.608	0.414-0.893
Age	0.021	0.023	0.863	1	0.353	1.022	0.976-1.069
Sedation (1)	0.196	0.209	0.884	1	0.347	1.217	0.808-1.832
BBPS	-0.060	0.054	1.241	1	0.265	0.942	0.847-1.047
Diverticulosis (1)	-0.328	0.208	2.503	1	0.114	0.720	0.479-1.082
Operations (1)	0.130	0.197	0.434	1	0.510	1.139	0.774-1.675
BMI	0.034	0.017	4.232	1	0.040b	1.035	1.002-1.069

^aP < 0.05 vs female sex.

^bP < 0.05 vs group with body mass index < 25 kg/m².

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; df: Degrees of freedom.

Table 13 Multivariable logistic regression analysis for adenoma detection rate in the age group ≥ 75 years

Variable	B	S.E.	Wald	df	Sig.	Exp(B)	95%CI for Exp(B) (lower-upper)
Sex (1)	-0.036	0.284	0.016	1	0.901	0.965	0.553-1.685
Age	-0.063	0.038	2.705	1	0.100	0.939	0.871-1.012
Sedation (1)	-0.653	0.326	4.009	1	0.045a	0.520	0.275-0.986
BBPS	0.082	0.073	1.254	1	0.263	1.086	0.940-1.254
Diverticulosis (1)	-0.311	0.289	1.159	1	0.282	0.732	0.416-1.291
Operations (1)	0.012	0.284	0.002	1	0.967	1.012	0.579-1.767
BMI	0.065	0.033	3.883	1	0.049b	1.067	1.000-1.138

^aP < 0.05 vs sedation-free group.

^bP < 0.05 vs group with body mass index < 25 kg/m².

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; df: Degrees of freedom.

Table 14 Multivariable logistic regression analysis for cecal intubation rate in the age group 60-74 years

Variable	B	S.E.	Wald	df	Sig.	Exp(B)	95%CI for Exp(B) (lower-upper)
Sex	-0.681	0.623	1.195	1	0.274	0.506	0.149-1.716
Age	0.056	0.086	0.427	1	0.514	1.058	0.894-1.253
Sedation (1)	-0.232	0.766	0.092	1	0.762	0.793	0.177-3.559
BBPS	0.544	0.119	20.911	1	0.000a	1.724	1.365-2.177
Diverticulosis (1)	0.748	0.714	1.099	1	0.294	2.113	0.522-8.562
Operations (1)	0.100	0.610	0.027	1	0.870	1.105	0.334-3.655
BMI	0.063	0.058	1.181	1	0.277	1.065	0.951-1.193

^aP < 0.05 vs group with lower Boston bowel preparation scale.

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; df: Degrees of freedom.

Table 15 Multivariable logistic regression analysis for cecal intubation rate in the age group ≥ 75 years

Variable	B	S.E.	Wald	df	Sig.	Exp(B)	95%CI for Exp(B) (lower-upper)
Sex	-0.681	0.623	1.195	1	0.274	0.506	0.149-1.716
Age	0.056	0.086	0.427	1	0.514	1.058	0.894-1.253
Sedation (1)	-0.232	0.766	0.092	1	0.762	0.793	0.177-3.559
BBPS	0.544	0.119	20.911	1	0.000a	1.724	1.365-2.177
Diverticulosis (1)	0.748	0.714	1.099	1	0.294	2.113	0.522-8.562
Operations (1)	0.100	0.610	0.027	1	0.870	1.105	0.334-3.655
BMI	0.063	0.058	1.181	1	0.277	1.065	0.951-1.193

^aP < 0.05 vs group with lower Boston bowel preparation scale.

CI: Confidence interval; BBPS: Boston bowel preparation scale; BMI: Body mass index; df: Degrees of freedom.