Ciprofol vs propofol for gastrointestinal endoscopy sedation: a systematic review and meta-analysis

Ciprofol, a propofol derivative, is increasingly used for sedation in China. However, the specific benefits of ciprofol in gastrointestinal endoscopic sedation have not been fully evaluated. This meta-analysis aimed to compare the efficacy and safety of ciprofol with propofol in gastrointestinal endoscopy.

Four public databases were searched for the relevant literature to February 1, 2025. Studies were excluded based on predefined criteria, and the characteristics and outcome data of each included study were collected. Subsequently, meta-analysis and trial sequential analysis (TSA) were performed using Review Manager 5.3 and TSA 0.9.5.10 Beta, respectively.

Nine studies involving 1860 participants were included in this study. Compared with propofol, ciprofol significantly reduced rates of hypotension (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.63-0.89), respiratory depression (RR 0.71, 95% CI 0.56-0.91), hypoxemia (RR 0.65, 95% CI 0.48-0.87), choking cough (RR 0.74, 95% CI 0.57-0.95), and injection pain (RR 0.11, 95% CI 0.06-0.22). Awakening time of ciprofol was slightly prolonged (mean difference 0.81 minutes, 95% CI 0.02-1.61), though not clinically significant. Bradycardia, involuntary movement, dizziness, nausea, and vomiting were comparable between the two groups ( P > 0.05). Moreover, TSA demonstrated that the results of hypotension, hypoxemia, respiratory depression, and injection pain observed in the current sample size were decisive. Regression analysis did not reveal any potential publication bias.

Ciprofol offers notable advantages over propofol in gastrointestinal endoscopic sedation, including a lower incidence of injection pain, hypotension, respiratory depression, and hypoxemia. A dosage of 0.4 mg/kg of ciprofol may be an effective alternative to propofol, as it further reduces the risk of involuntary movements. However, caution is warranted, as ciprofol may increase the risk of dizziness during procedures lasting 10 minutes or longer.