Propofol-Associated Hypoxia and Hypotension During Endoscopic Retrograde Cholangiopancreatography: A Systematic Review

BACKGROUND: Propofol is widely used for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP) due to its rapid onset and favorable recovery profile; however, it is associated with dose-dependent cardiopulmonary adverse effects, particularly hypoxia and hypotension. AREAS OF UNCERTAINTY: Significant heterogeneity persists in the definition, severity classification, and reporting of these adverse events, limiting comparability across studies and hindering reliable risk stratification. Therefore, the aim of this systematic review was to evaluate the incidence and clinical characteristics of propofol-associated hypoxia and hypotension in adult patients undergoing ERCP, and to assess variability in reporting practices across studies. DATA SOURCES: A systematic review was conducted and reported in accordance with PRISMA guidelines. PubMed was searched for English-language studies published between 1995 and 2025 involving adult patients undergoing ERCP under propofol-based sedation. RESULTS: Across studies reporting extractable data, oxygen desaturation occurred in 16.9% of aggregated cases (1194/7049), whereas hypotension occurred in 13.0% (187/1440). These values represent descriptive estimates and should not be interpreted as meta-analytic pooled incidences. Both events were predominantly mild and transient, responding to standard supportive measures, whereas severe complications, including cardiopulmonary arrest, were exceptionally rare. Considerable variability in definitions, outcome reporting, and study design was observed across studies. CONCLUSIONS: Propofol sedation during ERCP is associated with frequent but generally manageable hypoxia and hypotension. Continuous respiratory and hemodynamic monitoring facilitates early recognition and prompt intervention. Standardization of outcome definitions and reporting, along with the development of structured risk stratification tools, may improve patient selection and enhance procedural safety.