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P0234 - The Effect of Deep Sedation on Adenoma Detection Rate in Screening Colonoscopies: A Meta-Analysis and Systematic Review

Sunday, October 27

3:30 PM - 7:00 PM

Location: Exhibit Halls 3 and 4 (Street Level)

Award: Presidential Poster Award

Presenting Author(s)

Mohammad Alomari, MD

Resident
Cleveland Clinic Foundation
Cleveland, Ohio

Mohammad Alomari, MD¹, Laith Al Momani, MD², Hunter Bratton³, Tyler Aasen, MD², Prashanthi N. Thota, MD⁴, Madhusudhan R. Sanaka, MD, FACG⁴

¹Cleveland Clinic Foundation, Cleveland, OH; ²East Tennessee State University, Johnson City, TN; ³Quillen College of Medicine, Johnson City, TN; ⁴Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH

Introduction: The cornerstone of colon cancer prevention is high-quality examination of the entire colonic mucosa at designated intervals. Deeper sedation has been correlated to greater patient satisfaction, shorter procedures, and faster recoveries. However, disagreement exists on whether deeper sedation correlates to an increase in adenoma detection rate (ADR); a surrogate marker of colonic visualization. The aim of this meta-analysis is to evaluate the previously published research on the difference in ADR in colon cancer screening colonoscopies between deep and moderate sedation (i.e. conscious sedation).

Methods: We performed a comprehensive literature search in PubMed, PubMed Central, Embase, and ScienceDirect databases from inception through May 2019, to identify all human studies that evaluated the association between deep sedation with Propofol versus moderate sedation and the rate of adenoma detection. We included studies that presented an odds ratio (OR) with a 95% confidence interval (CI) or included data sufficient to calculate the OR with a 95% CI. Statistical analysis was performed using the Comprehensive Meta-Analysis (CMA), Version 3 software.

Results: Five studies with a total of 112,098 patients undergoing screening colonoscopies were included in this study, 6,476 of which received deep sedation with Propofol (5.8%). The pooled OR for ADR in patients who underwent deep sedation with Propofol compared to moderate sedation is 1.137 (95% confidence interval: 1.019 – 1.269, P=0.022; I2 =37.756%). (Figure 1). No publication bias was found using Egger’s regression test. (Figure 2)

Discussion:

Our results indicate that patients receiving deep sedation with Propofol are 14 percent more likely to have adenoma detected during a screening colonoscopy than in those who are moderately sedated. To our knowledge, this study represents the first meta-analysis to assess this association. Future prospective randomized research is needed to confirm this association before making any changes in the standard practices of sedation during screening colonoscopies.

Figure 1. Summary of odd ratios assessing the adenoma detection rates with deep sedation.

Figure 2. Funnel plot of standard error by log odds ratio

Disclosures:

Mohammad Alomari indicated no relevant financial relationships.

Laith Al Momani indicated no relevant financial relationships.

Hunter Bratton indicated no relevant financial relationships.

Tyler Aasen indicated no relevant financial relationships.

Prashanthi Thota indicated no relevant financial relationships.

Madhusudhan Sanaka indicated no relevant financial relationships.

Citation: Mohammad Alomari, MD; Laith Al Momani, MD; Hunter Bratton; Tyler Aasen, MD; Prashanthi N. Thota, MD; Madhusudhan R. Sanaka, MD, FACG. P0234 - THE EFFECT OF DEEP SEDATION ON ADENOMA DETECTION RATE IN SCREENING COLONOSCOPIES: A META-ANALYSIS AND SYSTEMATIC REVIEW. Program No. P0234. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.