A Swedish registry compared propofol sedation with midazolam-opioid basic sedation and found tradeoffs across outcomes.
Among 31,001 first ERCP procedures, cannulation success was 89.0% with propofol and 86.7% with basic sedation. Intraprocedural complications were less frequent with propofol, but overall postprocedural complication frequency did not differ significantly. Pancreatitis was more common and procedures longer in the propofol group.
Sedation was not randomly assigned. Patient selection, procedure difficulty, operator behavior, and center practice could influence the associations. The authors suggested more aggressive cannulation as one possible explanation for pancreatitis, rather than demonstrating that mechanism. The findings cannot be reduced to a claim that either regimen was simply safer. A case assessment should separate procedural completion, immediate events, and later complications, while retaining the benzodiazepine-opioid combination actually used as the comparator.
Original analysis of the supplied journal article, identified as PMC7196618.