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

Background: The risk of hepatic encephalopathy (HE) precipitated by propofol has not been established. Objective: To know whether the use of propofol for endoscopy in patients with cirrhosis induces minimal or overt HE. Design: A cohort study. Setting: A tertiary-referral university hospital endoscopy unit. Patients: Patients with cirrhosis who received an endoscopy with propofol sedation. We excluded patients with clinical HE. A group of patients without liver disease was included to compare the incidence of adverse effects. Interventions: Minimal HE (MHE) was diagnosed by using the psychometric hepatic encephalopathy score (PHES) battery of psychometric tests. Cognitive status before and I hour after the endoscopy was evaluated by measuring the critical flicker frequency (CFF). Main Outcome Measurements: Overt and minimal HE. Results: Twenty patients with cirrhosis and 20 patients without cirrhosis were included. There were no differences between groups in the incidence of adverse effects. Thirteen patients (65%) had MHE before the endoscopy. No patient developed overt HE after sedation. We did not observe differences in CFF before and after sedation in patients without MHE: median (25th-75th percentile), 40.8 Hz (37.1-46.0 Hz) versus 41.1 Hz (36.0-44.3 Hz), P =.8). None of the patients who were without MHE showed a decrease in the CFF under the cutoff of 39 Hz after sedation. There were not significant changes in CFF before and after propofol sedation in patients previously diagnosed of MHE: median (25th-75th percentile), 40.6 Hz (36.8-49.1 Hz) versus 42.7 Hz (36.8-52.4 Hz), P =.08. Limitation: A small number of patients were included in the study. Conclusions: The use of propofol in the sedation of patients with cirrhosis during endoscopic procedures does not precipitate minimal or overt HE. (Gastrointest Endosc 2009;70:262-8.)