Pharyngeal observation is an essential but technically demanding step in esophagogastroduodenoscopy (EGD), particularly for trainees. This study evaluated the impact of sedation method on pharyngeal observation, procedure efficiency, and safety, with a focus on trainee performance.

We retrospectively analyzed 444 consecutive EGDs performed between April 2024 and March 2025 (trainees, n=327; attending physicians, n=117). Patients were classified into a propofol group (n=199) and a midazolam group (n=245). Patient characteristics were comparable between groups. Outcomes included pharyngeal observation rate, procedure time, safety (hypotension and oxygen desaturation), patient satisfaction, and discomfort. Factors associated with successful pharyngeal observation were assessed using multivariable analysis.

Overall, the pharyngeal observation rate was significantly higher in the propofol group than in the midazolam group (91.5% vs 83.3%, p=0.0110), with a shorter procedure time (6.7±2.4 vs 7.9±3.0 min, p<0.0001). Safety and patient satisfaction were comparable between groups. Similar results were observed after excluding cases with biopsy.Among trainee-performed EGDs, the pharyngeal observation rate (89.9% vs 80.3%, p=0.0205) and procedure time (7.2±2.6 vs 8.6±3.0 min, p<0.0001) favored propofol sedation, whereas no significant differences were observed among attending physicians. In the midazolam group, trainees had a significantly lower observation rate than attending physicians (p=0.0256), while no such difference was seen in the propofol group. Multivariable analysis identified propofol use as an independent predictor of successful pharyngeal observation (OR 2.21, p=0.0077) and shorter procedure time.

In a real-world training setting, propofol sedation improved the pharyngeal observation rate and reduced procedure time during EGD, particularly among trainees. Optimization of the sedation environment may enhance technical acquisition in the early learning phase without compromising safety.