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14-03-2013 | Gastroenterology | Article

Colonoscopy may be more risky under anesthesia

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medwireNews: The risk for aspiration and other complications related to colonoscopy may be increased if the procedure is performed under propofol-induced deep sedation, US study findings suggest.

However, the absolute risk for such complications after colonoscopy appears low, irrespective of the use of anesthesia.

In the study, complications occurred more often when colonoscopy was performed with rather than without anesthesia, at respective rates of 0.22% and 0.16%.

Aspiration occurred in 0.14% of colonoscopies performed under propofol-induced sedation (n=35,128) and in 0.10% of procedures performed without deep sedation (n=130,399).

The authors say that the observed risk increase "may result in part from uncontrolled confounding, but they may also reflect the impairment of normal patient responses with the use of deep sedation."

The findings, published in JAMA Internal Medicine, arise from the analysis of data from a US database of Medicare beneficiaries who underwent outpatient colonoscopy without polypectomy from 2000 through 2009. Thirty-day postoperative outcomes relating to 165,527 colonoscopies (n=100,359 patients aged ≥66 years) recorded in the database were assessed.

Gregory Cooper (University Hospitals Case Medical Center, Cleveland, Ohio) and team report that complications, namely aspiration, splenic injury, and bowel perforation, occurred in 0.17% (n=284) of procedures.

Multivariate analysis revealed that the use of anesthesia during the procedure significantly raised the risk for all complications, by 46%. Other predictors for increased complication risk were the presence of comorbidity, a patient age greater than 70 years, and carrying out the procedure in a hospital setting.

In an accompanying editorial, Karen Wernli (Group Health Research Institute, Seattle, Washington) and John Inadomi (University of Washington School of Medicine, Seattle) say that the current study findings are important "because the trend among gastroenterology practices is for colonoscopy to be performed with propofol, and this study raises concern about such a practice given that the purpose of screening colonoscopy is to reduce cancer mortality without incurring additional harm."

They advocate that future research should focus on identifying the patient subgroups in which the benefit offered by propofol-based sedation outweighs the potential risk for complications.

By Lauretta Ihonor, medwireNews Reporter

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