Source: DGNews  |  Posted 2 years ago

By Ed Susman

CHICAGO -- June 2, 2009 -- Performing colonoscopy with patients under deep sedation increases the yield of large polyps by about 25% when compared with performing the procedure when the patient has been administered moderate conscious sedation, researchers stated here on June 2 at Digestive Disease Week (DDW) 2009.

In a retrospective study, researchers led by Katherine Hoda, MD, Oregon Health and Science University, Portland, Oregon, identified 101,367 patients who underwent colonoscopies and were given moderate conscious sedation at multiple centres in the United States. Deep sedation was employed in 3,501 procedures.

“Significantly more large polyps were found with deep sedation compared with moderate conscious sedation,” Dr. Hoda said.

Among the patients who received deep sedation, 251 polyps that were 9 mm in diameter or larger or a suspected malignant tumour were discovered -- representing polyps in about 7.2% of these patients.

The clinicians discovered 6,109 large polyps among patients undergoing moderate conscious sedation (6.0% of the patients examined). The difference did achieve statistical significance (P = .01), Dr. Hoda reported.

Why the type of sedation makes a difference remains a question, she said. “It may be that patients with lesser sedation begin to get uncomfortable with the procedure and the doctor does the study more quickly than with a patient who has been administered deep sedation,” she suggested.

She did note at a press briefing that the use of deep sedation methods such as those obtained with propofol have been on the increase.

Dr. Hoda and colleagues queried the Clinical Outcomes Research Initiative (CORI) database, which compiles endoscopy reports from a network of 61 practice sites across the United States. This database was queried from January 2002 to December 2007 to identify all patients who underwent average risk screening colonoscopy done with moderate conscious sedation or colonoscopy done with deep sedation.

The mean age of the patients who received moderate conscious sedation was 61.3 years compared with 60.8 years for those receiving deep sedation (P <= .0002). About 54.6% of the moderate conscious sedation patients were men; 51.1% of deep sedation group were men (P <= .0001).

The majority of moderate conscious sedation patients (about 76.9%) and deep sedation patients (about 82.5%) were performed in the community practice settings.

Digestive Disease Week 2009 is cosponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society for Surgery of the Alimentary Tract (SSAT).

[Presentation title: More Large Polyps Are Seen on Screening Colonoscopy With Deep Sedation Compared With Moderate Conscious Sedation. Abstract 722]