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Does Level of Sedation Impact Detection of Advanced Neoplasia?

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Abstract

Background and Aims

Two of the foremost issues in screening colonoscopy involve delivering quality and maximizing adenoma detection rates (ADR). Little is known about the impact of deep sedation on ADR. This study aims to compare the detection of advanced lesions during screening colonoscopy performed with moderate conscious sedation (MCS) versus deep sedation (DS).

Methods

A retrospective cohort study was performed using the Clinical Outcomes Research Initiative database. Average risk screening colonoscopies performed January 2000 to December 2005 were examined for practice setting, patient demographics, and findings, including detection of a polyp >9 mm and suspected malignant lesions.

Results

A total of 104,868 colonoscopies were examined, 97% of which were performed with MCS. Univariate analysis demonstrated that more polyps of any size were detected with MCS (38 vs. 34%, p < 0.0001) and more advanced lesions were found with DS compared with MCS (7 vs. 6%, p = 0.01). When exclusively examining sites that performed DS > 10% for all procedures, a more significant increase in advanced lesion detection when using DS was observed (7.5 vs. 5.7%, p = 0.003). When adjusted for age, gender, race/ethnicity, site, prep quality, and ASA group, DS was 25% more likely to detect an advanced lesion.

Conclusions

Our data suggest that use of DS may be associated with a higher rate of advanced lesion detection. However, this retrospective design has limitations that necessitate follow-up with prospective studies. These follow-up studies would be essential to support any change in the standard practices of sedation.

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Abbreviations

ADR:

Adenoma detection rate

ASA:

America Society of Anesthesiologists

CORI:

Clinical outcomes research initiative

CI:

Confidence interval

DS:

Deep sedation

MCS:

Moderate conscious sedation

NED:

National endoscopic database

NH:

Non-Hispanic

OR:

Odds ratio

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Acknowledgments

This project was supported with funding from NIDDK UO1 CA 89389-01 and R33-DK61778-01. In addition, the practice network (CORI) has received support from the following entities to support the infrastructure of the practice-based network: AstraZeneca, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. The commercial entities had no involvement in this research. GE is the executive co-director of CORI, a nonprofit organization that receives funding from federal and industry sources. This potential conflict of interest has been reviewed and managed by the Oregon Health and Science University (OHSU) Conflict of Interest in Research Committee.

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Authors and Affiliations

  1. Department of Gastroenterology, Oregon Health and Science University, 3303 SW Bond Avenue, CHH6D, Portland, OR, 97239, USA

    A. Wang, K. M. Hoda, J. L. Holub & G. M. Eisen

Authors
  1. A. Wang
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  2. K. M. Hoda
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  3. J. L. Holub
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  4. G. M. Eisen
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Correspondence to A. Wang.

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Wang, A., Hoda, K.M., Holub, J.L. et al. Does Level of Sedation Impact Detection of Advanced Neoplasia?. Dig Dis Sci 55, 2337–2343 (2010). https://doi.org/10.1007/s10620-010-1226-1

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  • DOI: https://doi.org/10.1007/s10620-010-1226-1

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