Ciprofol versus propofol for sedation in colonoscopy: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Ciprofol has emerged as a potential alternative sedative with improved safety and efficacy. However, comparative data for colonoscopy sedation remain limited.

METHODS

A systematic search in PubMed, Embase, Cochrane Library, and Web of Science identified RCTs published through August 2025. Studies included patients undergoing colonoscopy using ciprofol or propofol, reporting relevant efficacy or safety outcomes. Risk Ratios (RRs) and Mean Differences (MDs) were calculated using the Mantel-Haenszel random-effects model and 95% Confidence Intervals. The heterogeneity was assessed with I² statistics and Cochrane Q test. Primary outcomes were procedure success rate and patient satisfaction (assessed on a 1-to-10 scale). Secondary outcomes included sedation onset time(s), respiratory depression, injection pain, and hemodynamic adverse events (hypotension and bradycardia). The statistical analyses were performed in R software (version 4.4.1.)

RESULTS

Three RCTs with 645 patients were included. Colonoscopy success rates were similar between ciprofol and propofol (RR = 1.005; 95% CI 0.992-1.019). Ciprofol showed a lower risk of respiratory depression (RR = 0.24; 95% CI 0.08-0.71), injection pain (RR = 0.04; 95% CI 0.01-0.15), and hypotension (RR = 0.85; 95% CI 0.75-0.96). Patient satisfaction was slightly higher with ciprofol (MD = 0.18; 95% CI 0.08-0.29). No significant differences were found in sedation onset time (s) (MD = 2.49s; 95% CI -3.77-8.74) or bradycardia (RR = 0.88; 95% CI 0.44-1.77).

CONCLUSION

Ciprofol provides comparable efficacy to propofol for colonoscopy sedation, with a lower incidence of respiratory depression, injection pain, and hypotension. Patient satisfaction was slightly higher with ciprofol, while bradycardia occurrence was similar. These findings suggest ciprofol as a promising alternative, though further large-scale studies are needed to confirm its clinical benefits.