Patient Satisfaction of Deep Propofol Sedation Versus Moderate Midazolam and Fentanyl Sedation During Colonoscopy in Inflammatory Bowel Disease: A Randomized Controlled Trial & NBSP

Aims Colonoscopy is essential for optimal management of inflammatory bowel disease (IBD) to ensure pivotal endoscopic treatment goals, notably mucosal healing. However, colonoscopy is not favored by patients and many opt out due to unpleasantness of the procedure. We aimed to investigate if Nurse Administered Propofol Sedation (NAPS) improves patient satisfaction and attitude towards future colonoscopies.

Methods Randomized controlled trial of deep sedation with NAPS (n = 63) versus moderate midazolam and fentanyl sedation (n = 67). To assess the primary end-point of patient satisfaction at discharge, we developed a Satisfaction Questionnaire comprising 13 items each rated by a 5-point Likert scale and with higher scores reflecting more positive outcomes (13-65 points). Clinicaltrials.gov NCT01934088.

Results Fifty-six patients (43 %) with ulcerative colitis, 48 (37 %) with Crohn’s disease, and 26 (20 %) with suspected IBD were included. Most (88 %) had previously had a colonoscopy and pre-procedure expectations were similar between groups. Patients receiving deep sedation had significantly higher satisfaction scores (mean 60.1, SD 3.4) than those receiving moderate sedation (51.2, 8.4; p<0.001). This was driven by less pain, more amnesia, sedation more to their liking, and better experience with the current than previous sedations. Importantly, these patients significantly more often preferred the same sedation for a future colonoscopy and were also inclined to accept more frequent colonoscopies. Subgroup analysis including patients with established IBD only revealed similar results. Explorative exclusion of patients with perianal disease or previous abdominal surgery also revealed similar findings. Assistance from another colonoscopist and disruption of the procedure due to pain occurred significantly more frequent in the moderate sedation group. There were no safety issues associated with NAPS.

Conclusions IBD patients favor deep propofol sedation over moderate midazolam and fentanyl sedation. Availability of deep propofol sedation (NAPS) and honoring patients’Final diagnosis was established through a request for sedation depth may facilitate improved patient adherence to endoscopy-based IBD monitoring programmes.

Citation Steenholdt C, Jensen J, Brynskov J et al. eP400 PATIENT SATISFACTION OF DEEP PROPOFOL SEDATION VERSUS MODERATE MIDAZOLAM AND FENTANYL SEDATION DURING COLONOSCOPY IN INFLAMMATORY BOWEL DISEASE: A RANDOMIZED CONTROLLED TRIAL & NBSP. Endoscopy 2021; 53: S227.

Publication History

Article published online:
19 March 2021