Deep sedation with propofol does not precipitate hepatic encephalopathy during elective upper endoscopy

Area of Science:

• Hepatology
• Anesthesiology
• Gastroenterology

Background:

• The potential for propofol to precipitate hepatic encephalopathy (HE) in patients with cirrhosis remains unclear.
• Establishing the safety of propofol sedation in this vulnerable patient population is crucial for clinical practice.

Purpose of the Study:

• To investigate whether propofol sedation during endoscopic procedures induces minimal or overt hepatic encephalopathy (HE) in patients with cirrhosis.
• To assess the incidence of HE in patients with cirrhosis undergoing endoscopy with propofol compared to a control group.

Main Methods:

• A cohort study was conducted at a tertiary-referral university hospital.
• Patients with cirrhosis undergoing endoscopy with propofol sedation were evaluated, excluding those with pre-existing clinical HE.
• Minimal HE (MHE) was diagnosed using the psychometric hepatic encephalopathy score (PHES) battery, and cognitive status was assessed via critical flicker frequency (CFF) before and after sedation.

Main Results:

• Twenty patients with cirrhosis and 20 controls were included; no significant differences in adverse effects were observed between groups.
• Thirteen (65%) of cirrhosis patients had MHE prior to endoscopy; none developed overt HE post-sedation.
• No significant changes in CFF were detected before and after propofol sedation in either MHE or non-MHE patients.

Conclusions:

• Propofol sedation for endoscopic procedures in patients with cirrhosis does not appear to precipitate minimal or overt hepatic encephalopathy.
• While preliminary due to a small sample size, these findings suggest propofol is a safe sedation option for endoscopy in this population.