The impact of non-anesthesiologist-administered propofol (NAAP) sedation on colonoscopy performance remains elusive. We aimed to assess the impact of NAAP on colonoscopy quality metrics published in recent literature.

A systematic review across MEDLINE and Cochrane Central Register for all types of trials was performed, evaluating the impact of NAAP compared to AP sedation on colonoscopy quality measures. The primary endpoint was Adenoma Detection Rate (ADR), while cecal intubation rate (CIR) and procedure length comprised the secondary endpoints. The effect size on study outcomes is presented either as the event rate or as the Risk Ratio (RR) with 95% confidence interval (CI). We assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Two RCTs and nine cohort studies with 3769 patients (NAAP 1959, AP 1810), published between 2019 and 2024, were included. NAAP resulted in similar ADR compared to AP [RR 1.06, 95% CI (0.94-1.19); I²=0%]. Similarly, no difference in terms of CIR [RR 1.01, 95% CI (0.98-1.04), I²=10%] as well as procedure length [MD -0.94, 95% CI (-2.79-0.91), I²=74%] was evident. Overall, the certainty of evidence was very low.     

The ADR and CIR colonoscopy quality indicators are comparable between NAAP and AP sedation.