The Impact of Sedation on Adenoma Detection Rate and Cecal Intubation Rate in Colonoscopy

Abstract

Purpose. To explore the effect of sedation on the quality of colonoscopy. Methods. The data collected from the Digestive Endoscopy Center of Shanghai Tongji Hospital from March 2012 to June 2019 were retrospectively analyzed. The rate of sedation and quality metrics of colonoscopy such as adenoma detection rate (ADR) and cecal intubation rate (CIR) were calculated. The logistic regression model was used to explore the relationship between sedation and quality metrics of colonoscopy. The interaction effects between experience of endoscopists and sedation on quality of colonoscopy was also investigated in subgroups stratified by total number of colonoscopies during career using the logistic regression model. Results. A total of 63,417 colonoscopies including 11,417 colonoscopies without sedation and 52,000 colonoscopies with sedation were enrolled in our study. The proportion of colonoscopy with sedation was 82.0%. The ADR and CIR were all significantly higher in cases with sedation compared with cases without sedation (ADR, 22.5% vs. 17.0%, $p<0.001$ ; CIR, 94.7% vs. 91.2%, $p<0.001$ ). Multivariate analysis showed that the sedation was an independent factor associated with adenoma detection ( $\text{OR}=1.448$ , 95% CI: 1.372~1.529, $p<0.001$ ) and cecal intubation ( $\text{OR}=1.560$ , 95% CI: 1.446~1.683, $p<0.001$ ). A total of 14 endoscopists with complete colonoscopy data in our database and corresponding 20,949 colonoscopies data were enrolled for further analysis. The logistic regression model yielded a similar result that sedation was an independent factor on adenoma detection and cecal intubation when the factor, experience of endoscopists, was also entered into the model as a confounder (adenoma detection, $\text{OR}=1.408$ , 95% CI: 1.333~1.487, $p<0.001$ ; cecal intubation, $\text{OR}=1.601$ , 95% CI: 1.482-1.729, $p<0.001$ ). Conclusion. Colonoscopy with sedation has a positive effect on ADR and CIR in all endoscopists with different experience of colonoscopy, which makes the quality of colonoscopy better.