Comparison of missed adenomas in deep-sedated and unsedated colonoscopy: A multicenter retrospective study

• Published in: European journal of internal medicine 2023-04, Vol.110, p.48-53
• Main Authors: Sui, Yue, Zheng, Yanhua, Wang, Qing, Lv, Jieping, Wang, Hongjin, Wen, Qing, Wang, Zhenzhen, Wang, Guanfeng, Jia, Hui, Cao, Fengzhen, Wang, Naping, Hao, Junlian, Zhang, Yiping, Wu, Xiaopeng, Chen, Haihua, Lu, Junhui, Chen, Xing
• Format: Article
• Language: English
• Subjects: Adenoma; Adenoma - diagnosis; Colonoscopy; Colorectal cancer; Colorectal Neoplasms - diagnosis; Humans; Miss rate; Propofol; Retrospective Studies; Sedation; Time Factors
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2023.01.019

•The AMR was higher in deep-sedated colonoscopy than in unsedated colonoscopy;.•Adenomas in the splenic flexure and descending colon were more frequently missed;.•There was no such difference in the high-level endoscopists. Deep-sedated colonoscopy with propofol is widely used in China. However, its impact on quality metrics remains controversial. We aimed to investigate the effects of deep-sedated colonoscopy on missed adenomas, specifically in each colorectal segment. Data of 3710 individuals from seven hospitals in China who underwent an initial colonoscopy with or without propofol sedation and a second colonoscopy without sedation within six months for surveillance or polypectomy by endoscopist of the same level between October 2020 and September 2021 were retrospectively analyzed. A total of 1113 missed adenomas in 3710 patients were evaluated. The adenoma miss rate (AMR) was significantly higher in deep-sedated colonoscopy than in unsedated colonoscop [19.14% (578/3020) vs. 16.15% (535/3313), P < 0.05]. The risk of missing adenomas in deep-sedated colonoscopy was 1.229 times higher than in unsedated colonoscopy (OR, 1.229; 95% CI: 1.080–1.399). AMRs of the splenic flexure (26.02% [96/369] vs. 16.04% [47/293], P < 0.05) and descending colon (20.86% [102/489] vs. 13.37% [54/404], P < 0.05) were significantly higher in deep-sedated colonoscopy than in unsedated colonoscopy when performed by middle-level endoscopists rather than high-level endoscopists (P < 0.05). AMR was higher in deep-sedated colonoscopy than in unsedated colonoscopy. Furthermore, adenomas in the splenic flexure and descending colon were more frequently missed in deep-sedated colonoscopy than in unsedated colonoscopy, particularly when performed by less experienced endoscopists.