Paradigm shift: should the elderly undergo propofol sedation for DBE? A prospective cohort study

Area of Science:

• Gastroenterology
• Endoscopy
• Anesthesiology

Background:

• Double balloon enteroscopy (DBE) is a valuable tool for examining the small intestine.
• Sedation methods for DBE, particularly in elderly patients, require careful safety evaluation.
• Propofol is an alternative to conventional sedation (midazolam±fentanyl) for endoscopic procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of propofol-assisted DBE in elderly patients.
• To compare outcomes of propofol-assisted DBE in elderly versus younger patient cohorts.
• To assess diagnostic yield and complication rates across different sedation groups.

Main Methods:

• Prospective cohort study involving 161 patients undergoing 215 DBE procedures over 30 months.
• Patients were categorized as elderly (≥65 years) or young, and received either propofol or conventional sedation.
• Demographics, comorbidities, procedural data, diagnostic/therapeutic yield, and complications were compared.

Main Results:

• Elderly patients undergoing propofol-assisted DBE had higher prevalence of cardiovascular disease and ASA status.
• Diagnostic yield was significantly higher in elderly patients (75.3%) compared to younger patients (58.5%).
• Propofol sedation showed favorable tolerance scores, with no significant difference in complications across sedation groups or age cohorts.

Conclusions:

• Propofol-assisted DBE is a safe and effective procedure for elderly patients.
• The diagnostic yield of DBE is higher in the elderly population.
• Propofol provides comparable safety to conventional sedation for DBE in both elderly and young patients.