Can propofol reduce the risk of colon cancer?

A retrospective study showed better detection rates of precancerous lesions in patients receiving propofol for colonoscopies

If given a choice between receiving anesthesia with propofol for a colonoscopy or having it performed under what is commonly called conscious sedation (usually with midazolam and/or fentanyl), most people would prefer to receive propofol. Sedation with propofol, which is a deeper level of sedation, is generally more comfortable for patients. However, many facilities do not offer a choice of the type of sedation. Some places only use propofol, some only use conscious sedation, and some use a mix of the two.

In addition to patient comfort, there may be a more important reason to undergo a colonoscopy using propofol-based anesthesia. A retrospective study published this month looked at the difference in the detection rates of adenomas and serrated polyps between patients who underwent colonoscopies with propofol vs. conscious sedation (without propofol). Both adenomatous and serrated polyps have the potential to turn into colorectal cancer (CRC). During a colonoscopy, these lesions can be removed, preventing them from becoming cancer. How many polyps an endoscopist finds and removes is termed the adenoma detection rate (ADR), and it is highly correlated with a reduced risk of developing CRC.

The authors found that small (less than 1 cm) serrated polyps were detected at a higher rate in patients who received propofol. Detection of adenomas was not significantly different between the two groups. Additionally, the total number of polyps, adenomas, and neoplastic lesions detected were all higher in the propofol group compared to the group that did not receive propofol.

One possible explanation for this is that because patients are more relaxed, endoscopists are able to better perform the colonoscopies. Since this is a retrospective study, it has notable limitations. For example, it is possible that patients receiving propofol had more comorbidities and, therefore, an increased risk of CRC at baseline.

This study cannot establish causation, showing that sedation with propofol reduces the risk of CRC. However, other than a higher cost to performing these procedures with propofol, there is no advantage to using conscious sedation over propofol. Perhaps, for your next colonoscopy, you should request propofol for the sedation.