Systematic review and meta-analysis of patient-controlled sedation versus intravenous sedation for colonoscopy

Abstract

Background: Patient-controlled sedation (PCS) has been suggested as an alternative method for sedative colonoscopy. However, as any new techniques, PCS introduction as a potential alternative to traditional intravenous sedation (IVS) has brought about challenges. To evaluate the advantages and disadvantages between PCS and IVS more comprehensively, we conducted a systematic review and meta-analysis of the published literature.

Methods: Several databases were searched from inception to 1 April, 2015, for trials comparing PCS with IVS for colonoscopy. The outcomes of interest included time for cecal intubation, rate of complete colonoscopy, dose of sedative drugs used, pain scores, recovery time, complications. Inconsistency was quantified using I (2) statistics.

Results: In all, 12 trials were finally selected (1091 patients, with 545 in the PCS group, and 546 in the IVS group). The total propofol used, time for cecal intubation, rate of complete colonoscopy and pain score had no statistical difference between the two groups. However, PCS showed a reduction in the recovery time, incidence of oxygen desaturation and hypotension. The rates of other complications and patients' willingness to repeat the same sedation had no statistical difference between the two groups.

Conclusion: PCS is as feasible and effective as traditional IVS for colonoscopy, and there is a tendency that PCS shows its superiority in recovery time, incidence for oxygen saturation and hypotension.

Keywords: Sedation; colonoscopy; intravenous sedation; meta-analysis; patient-controlled sedation.

Figures

Figure 1

Flow chart of selection algorithm.

Figure 2

Summary of risk bias of the included studies.

Figure 3

Meta-analysis of the total propofol used. PCS, patient-controlled sedation; IVS, intravenous sedation.

Figure 4

Meta-analysis of the procedure time. A. Time for sedation preparation in fixed model; B. Time for sedation preparation in random model; C. Time for cecal intubation; D. Time for total procedure. PCS, patient-controlled sedation; IVS, intravenous sedation.

Figure 5

Meta-analysis of the rate of complete colonoscopy. PCS, patient-controlled sedation; IVS, intravenous sedation.

Figure 6

Meta-analysis of the complications. A. Rates for oxygen desaturation; B. Rates for hypotension; C. Rates for arrhythmia; D. Rates for amnesia and after-effect; E. Subgroup analysis of rates for amnesia and after-effect. PCS, patient-controlled sedation; IVS, intravenous sedation.

Figure 7

Meta-analysis of willingness to repeat the same sedation method. PCS, patient-controlled sedation; IVS, intravenous sedation.