CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E1070-E1076
DOI: 10.1055/a-1452-9242
Original article

Outcomes of colonoscopy with non-anesthesiologist-administered propofol (NAAP): an equivalence trial

Marco Alburquerque
1  Department of Gastroenterology, Hospital de Palamós, Girona, Spain
2  Department of Gastroenterology, Clínica Girona, Girona, Spain
,
Antonella Smarrelli
1  Department of Gastroenterology, Hospital de Palamós, Girona, Spain
,
Julio Chevarria Montesinos
3  Department of Nephrology, Beaumont Hospital, Dublin, Ireland
,
Sergi Ortega Carreño
4  Department of Nursing, Hospital de Palamós, Girona, Spain
,
Ana Zaragoza Fernandez
4  Department of Nursing, Hospital de Palamós, Girona, Spain
,
Alba Vargas García
1  Department of Gastroenterology, Hospital de Palamós, Girona, Spain
2  Department of Gastroenterology, Clínica Girona, Girona, Spain
,
Cesar Ledezma Frontado
1  Department of Gastroenterology, Hospital de Palamós, Girona, Spain
,
Lluís Vidal
1  Department of Gastroenterology, Hospital de Palamós, Girona, Spain
,
Montserrat Figa Francesch
2  Department of Gastroenterology, Clínica Girona, Girona, Spain
,
Ferrán González-Huix Lladó
2  Department of Gastroenterology, Clínica Girona, Girona, Spain
5  Department of Gastroenterology, Arnau de Vilanova University Hospital, Lleida, Spain
› Author Affiliations

Abstract

Background and study aims Efficacy and safety of NAAP for gastrointestinal endoscopy have been widely documented, although there is no information about the outcomes of colonoscopy when the endoscopist supervises the sedation. In this context, the aim of this trial was to determine the equivalence of adenoma detection rate (ADR) in colorectal cancer (CRC) screening colonoscopies performed with non-anesthesiologist-administered propofol (NAAP) and performed with monitored anesthesia care (MAC).

Patients and methods This was a single-blind, non-randomized controlled equivalence trial that enrolled adults from a national CRC screening program (CRCSP). Patients were blindly assigned to undergo either colonoscopy with NAAP or MAC. The main outcome measure was the ADR in CRCSP colonoscopies performed with NAAP.

Results We included 315 patients per group. The median age was 59.76 ± 5.81 years; 40.5 % of patients were women. The cecal intubation rate was 97 %, 81.8 % of patients had adequate bowel preparation, withdrawal time was > 6 minutes in 98.7 %, and the median global exploration time was 24.25 ± 8.86 minutes (range, 8–70 minutes). The ADR was 62.9 % and the complication rate (CR) was 0.6 %. Analysis by intention-to-treat showed an ADR in the NAAP group of 64.13 % compared with 61.59 % in the MAC group, a difference (δADR) of 2.54 %, 95 %CI: −0.10 to 0.05. Analysis by per-protocol showed an ADR in the NAAP group of 62.98 %, compared with 61.94 % in the MAC group, δADR: 1.04 %, 95 %CI: −0.09 to 0.07. There was no difference in CR (NAAP: 0,63 vs. MAC: 0.63); P = 1.0.

Conclusions ADR in colorectal cancer screening colonoscopies performed with NAAP was equivalent to that in those performed with MAC. Similarly, there was no difference in complication rates.



Publication History

Received: 01 November 2020

Accepted: 19 February 2021

Publication Date:
17 June 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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