Matthew Bechtold, MD, on Deep Sedation for Colon Cancer Screening

The debate over moderate sedation vs deep sedation for index average-risk screening colonoscopies is well known. Research has shown that both sedation methods are effective. However, each method has its own benefits and risks.

In a retrospective study, Matthew Bechtold, MD, a professor of clinical medicine at the University of Missouri School of Medicine, and colleagues evaluated data from 585 patients who had undergone colonoscopy with either moderate sedation or deep sedation. The researchers sought to determine how each method affects outcomes of the adenoma detection rate (ADR) or the polyp detection rate (PDR) in index average-risk colonoscopies for colon cancer screening.

Results showed that ADRs and PDRs were not significantly different between the groups.

Gastroenterology Consultant caught up with Dr Bechtold about the research.

Gastroenterology Consultant: What prompted you to conduct the study?

Matthew Bechtold: Colon cancer remains the second leading cause of cancer death in the United States. Colonoscopy is frequently used as a screening tool in the United States for colon cancer. Ensuring the best of all metrics to perform quality colonoscopies for colon cancer prevention is crucial for both patients and physicians. We wanted to see if deep sedation using propofol actually improves the ADR in screening colonoscopies relative to the moderate, conscious sedation.

GASTRO CON: What is the most important finding from the study?

MB: It does not look like there is a difference between the deep sedation and the moderate sedation in index average-risk screening colonoscopies for ADR. In health care today, there is a big concentration on cost. We wondered if propofol is worth the cost, especially with ADR. If you cannot justify the cost, then you have to look at other parameters. A limitation of our study was that it was retrospective and included one institution. A randomized controlled trial would definitely be the best avenue to find the absolute answers.

GASTRO CON: What are the challenges associated with deep sedation use?

MB: There are confounding variables, because with deep sedation, there must be a certified registered nurse anesthetist or an anesthesiologist present to administer that. So, there are extra costs involved with using a deeper sedation. The caveat to deeper sedation is that it is a lot faster. It can be more efficient, because patients go to sleep faster so they wake up relatively faster compared with the moderate, conscious sedation. It is important to look at your patient population to find out which method works best.

GASTRO CON: How can deep sedation improve colonoscopy quality for patients, as well as the overall experience?

MB: The experience under deep sedation for most is better than the experience under conscious sedation, the reason being it is a deeper sedation. Patients are fully asleep throughout the procedure, whereas in conscious sedation, patients are in a semi‑twilight state. Also, postoperatively, deep sedation wears off quicker with minimal to no gastrointestinal side effects. Conscious sedation can also increase the slowing of bowels, passage of gas, bloating, and grogginess for patients. Overall, patients prefer the deep sedation route, but again, we have to justify the cost.

Reference:

Turse EP, Dailey FE, Bechtold ML. Impact of moderate versus deep sedation on adenoma detection rate in index average-risk screening colonoscopies. Gastrointest Endosc. 2019;90(3):502-505. doi:10.1016/j.gie.2019.05.011.