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

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%; 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.