Feasibility and Safety Profile of Non‐anesthesiologist‐administered Propofol During Colorectal Endoscopic Submucosal Dissection: A Single‐center Study of 454 Procedures

ABSTRACT Objectives Studies of non‐anesthesiologist‐administered propofol (NAAP) during colorectal endoscopic submucosal dissection (ESD) are scarce, particularly in the elderly. We evaluated its feasibility across a broad age range and identified factors associated with sedation‐related adverse events. Methods We retrospectively analyzed 454 consecutive colorectal ESD procedures performed with NAAP in 405 patients at a tertiary center (January 2016–May 2024), stratified by age (<65, 65–74, and ≥75 years). Propofol was given by the endoscopy team as a weight‐based induction bolus and a continuous infusion titrated to target depth under multiparameter monitoring. New‐onset hypotension, bradycardia, and hypoxemia were compared among groups, with multivariable logistic regression for independent predictors. Results Mean age was 68.2 years; 54.8% of procedures were performed in men. Adverse events were common but all transient: hypotension 14.1%, bradycardia 14.8%, hypoxemia 11.9%, without procedure discontinuation, intubation, anesthesiologist rescue, death, or permanent sequelae. A composite event (33.3%) rose with age (24.7%, 36.1%, and 39.1%; p = 0.018). In multivariable analysis, longer procedure duration, measured as propofol administration time, was independently associated with composite events (adjusted odds ratio [aOR] 1.05 per 10 min; p = 0.011) and bradycardia (aOR 1.07 per 10 min; p = 0.002). Age ≥75 years (vs. <65 years) was independently associated with composite events (aOR 1.85; p = 0.027) and hypoxemia (aOR 2.55; p = 0.021). Conclusions Propofol‐based NAAP allowed colorectal ESD to be completed across all age groups without sedation‐related procedure termination or escalation of care. Older age and longer procedure duration were associated with selected sedation‐related adverse events, providing clinically relevant information for risk assessment during colorectal ESD. Trial Registration N/A.