Feasibility and Safety Profile of Non-anesthesiologist-administered Propofol During Colorectal Endoscopic Submucosal Dissection: A Single-center Study of 454 Procedures.

OBJECTIVES

Studies of non-anesthesiologist-administered propofol (NAAP) during colorectal endoscopic submucosal dissection (ESD) are scarce, particularly in the elderly. We evaluated its feasibility across a broad age range and identified factors associated with sedation-related adverse events.

METHODS

We retrospectively analyzed 454 consecutive colorectal ESD procedures performed with NAAP in 405 patients at a tertiary center (January 2016-May 2024), stratified by age (<65, 65-74, and ≥75 years). Propofol was given by the endoscopy team as a weight-based induction bolus and a continuous infusion titrated to target depth under multiparameter monitoring. New-onset hypotension, bradycardia, and hypoxemia were compared among groups, with multivariable logistic regression for independent predictors.

RESULTS

Mean age was 68.2 years; 54.8% of procedures were performed in men. Adverse events were common but all transient: hypotension 14.1%, bradycardia 14.8%, hypoxemia 11.9%, without procedure discontinuation, intubation, anesthesiologist rescue, death, or permanent sequelae. A composite event (33.3%) rose with age (24.7%, 36.1%, and 39.1%; p = 0.018). In multivariable analysis, longer procedure duration, measured as propofol administration time, was independently associated with composite events (adjusted odds ratio [aOR] 1.05 per 10 min; p = 0.011) and bradycardia (aOR 1.07 per 10 min; p = 0.002). Age ≥75 years (vs. <65 years) was independently associated with composite events (aOR 1.85; p = 0.027) and hypoxemia (aOR 2.55; p = 0.021).

CONCLUSIONS

Propofol-based NAAP allowed colorectal ESD to be completed across all age groups without sedation-related procedure termination or escalation of care. Older age and longer procedure duration were associated with selected sedation-related adverse events, providing clinically relevant information for risk assessment during colorectal ESD.

TRIAL REGISTRATION: N/A.