Background and study aims: The majority of colonoscopies in Germany are performed under conscious sedation.
Previous studies reported that pediatric colonoscopes reduce the demand for sedative
drugs and may improve cecal intubation. The aim of this study was to compare a new
ultrathin and a standard colonoscope in terms of propofol demand during colonoscopy.
Patients and methods: A total of 203 patients were prospectively randomized to undergo colonoscopy with
either a 9.5-mm ultrathin (UTC) colonoscope or a standard colonoscope of variable
stiffness. Initially, 40 or 60 mg of propofol were administered according to body
weight, followed by bolus injections of 20 mg as deemed necessary. Propofol was administered
by a separate physician who was blinded to the endoscope used. Sedation levels were
defined according to guidelines; pain and complaints were recorded on a numeric rating
scale.
Results: Significantly less propofol was required to reach the cecum with the UTC (adjusted
mean 94.9 mg [95 % confidence interval (CI) 85.7 – 105.0] vs. 115.3 mg [95 %CI 105.8 – 124.7];
P = 0.003). The level of sedation and pain score were lower with the UTC (sedation
level 1 76 % vs. 61 %; P = 0.003; pain score adjusted mean 2.0 [95 %CI 1.7 – 2.4] vs. 2.8 [95 %CI 2.5 – 3.1];
P = 0.001). The rate of ileal and cecal intubation, time to reach the cecum, number
of external compressions, withdrawal time, polyp and adenoma detection rate, and patient
satisfaction were not different between the two colonoscopes. The time to intubate
the ileum was longer with the UTC (1.73 minutes [95 %CI 1.42 – 2.04] vs. 1.22 minutes
[95 %CI 0.91 – 1.52]; P = 0.020).
Conclusions: Use of a new ultrathin colonoscope was associated with reduced propofol consumption,
lower patient sedation levels, and less pain than the standard colonoscope, but ileal
intubation time was longer.
