Endoscopy 2020; 52(S 01): S188-S189
DOI: 10.1055/s-0040-1704586
ESGE Days 2020 ePoster Podium presentations
Friday, April 24, 2020 14:30–15:00 Safety of endoscopy ePoster Podium 8
© Georg Thieme Verlag KG Stuttgart · New York

PROPOFOL VERSUS MIDAZOLAM SEDATION FOR ELECTIVE ENDOSCOPY IN PATIENTS WITH CIRRHOSIS. A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

JL Guacho
1   University of São Paulo Medical School – Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
IB Ribeiro
1   University of São Paulo Medical School – Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
DTH de Moura
1   University of São Paulo Medical School – Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
M Coronel
1   University of São Paulo Medical School – Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
WM Bernardo
1   University of São Paulo Medical School – Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
P Sakai
1   University of São Paulo Medical School – Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
EGH de Moura
1   University of São Paulo Medical School – Gastrointestinal Endoscopy Unit, São Paulo, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Patients with cirrhosis frequently require sedation for elective endoscopic procedures. Several sedation protocols are available, but choosing an appropriate sedative in patients with cirrhosis is challenging. We aimed to conduct a systematic review and meta-analysis of available literature to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best approach.

Methods This systematic review and meta-analysis was performed using PRISMA guidelines. Electronic searches using MEDLINE, EMBASE, Central Cochrane, Latin-American, and Caribbean Health Sciences Literature (LILACS) databases. Only randomized control trials (RCTs) comparing midazolam and propofol sedation for elective endoscopy in patients with cirrhosis were included. The primary outcomes of interest were procedure time, recovery time, time to discharge, and adverse events, including bradycardia, hypotension, and hypoxemia.

Results The search yielded 3,576 records. Out of these, 8 RCTs with a total of 596 patients (302 in the Propofol group and 294 in the Midazolam group) were included for the final analysis. The procedure time was similar between the groups ((MD 0.25 (95%CI −0.64–1.13), p-value < 0.59). The recovery time was significantly less in the propofol group as compared to the midazolam group (MD −8.19 (95%CI −10.59 – −5.79), p-value < 0.00001). Similarly, the time to discharge was significantly less in the propofol group (MD −12.98 (95%CI −18.46 – −6.50), p-value < 0.00001) (Figure 2). Adverse events were similar in both the groups (RD 0.02 (95%CI 0–0.04), p-value 0.58). Moreover, no significant difference was found for each individual adverse event (bradycardia RD 0.03 (95%CI −0.01–0.07), p-value 0.16; hypotension RD 0.03 (95% CI −0.01–0.07), p-value 0.17 and hypoxemia RD 0.00 (95%CI −0.04–0.04), p-value 0.93).

Conclusions Propofol has shorter recovery and patient discharge time as compared to midazolam. However, there is no difference in adverse events.