Impact of sedation on adenoma and polyp detection rates and cecal intubation in elderly patients undergoing screening colonoscopy

BACKGROUND Increasing age is a major risk factor for colorectal neoplasia, with older adults showing a higher incidence of adenomas compared to individuals under 60 years. Early detection of colonic adenomas and polyps significantly reduces the risk of colorectal cancer. Key quality indicators for colonoscopy include the adenoma detection rate (ADR), polyp detection rate (PDR), and cecal intubation rate (CIR). However, studies comparing these metrics in elderly patients deeply sedated with propofol vs those undergoing colonoscopy without sedation show mixed results. AIM To evaluate deep propofol sedation vs no sedation impact on ADR, PDR, and CIR in elderly patients undergoing screening colonoscopy. METHODS This retrospective cohort study included adults over 60 years who underwent their first screening colonoscopy between January 2017 and September 2023. Exclusion criteria were emergency procedures, inflammatory bowel disease, procedures performed for therapeutic intent, and inadequate bowel preparation [Boston Bowel Preparation Scale (BBPS) score below 6]. Normality was tested by the Kolmogorov-Smirnov test; continuous variables were compared by the Mann-Whitney U test, categorical variables using the χ 2 or Fisher’s exact test. Binary logistic regression identified significant outcome predictors. RESULTS A total of 2034 patients (46.4% female; mean age: 70 years) were included, of whom 622 (30.6%) underwent colonoscopy under deep sedation. The overall PDR was 51.65%, ADR was 33.3%, and CIR was 94.25%. After adjusting for confounders [age, sex, body mass index (BMI), BBPS, operation, and diverticulosis], no significant differences were observed in PDR (51.8% vs 51.5%), ADR (33.5% vs 32.5%), or CIR (93.2% vs 95.3%) between the no-sedation and deep-sedation groups. Higher BMI (B = 0.96, P < 0.01) and male sex (B = 0.64, P < 0.01) were independent predictors of higher ADR. CONCLUSION In this elderly cohort, propofol-induced deep sedation did not significantly improve ADR, PDR, or CIR. Further research is warranted to clarify its effect on colonoscopy quality metrics in older populations.