Comparison of ciprofol and propofol for endoscopic retrograde cholangio-pancreatography anesthesia in Chinese patients: a systematic review and meta-analysis

Juan Deng^1*Yunfeng Yu¹Yuman Yin²Xinyu Yang²Rong Yu²Zhenjie Liu^1*

• ¹Department of Gastroenterology, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
• ²School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Anhui Province, China

Objective: The potential of ciprofol in endoscopic anesthesia is receiving increasing attention. Compared to propofol, ciprofol exhibits stronger sedative effects and requires a lower dosage. This study aimed to compare the safety of ciprofol and propofol in Chinese patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) anesthesia. Methods: A comprehensive literature search was conducted across eight common databases before January 1, 2025, including PubMed, Embase, the Cochrane Library, and Web of Science, CNKI, CSTJ, WanFang, and SinoMed. After screening the literature according to established standards, the meta-analysis and TSA were conducted using Review Manager 5.3 and TSA 0.9.5.10 beta, respectively. Finally, publication bias for each outcome was assessed using Harbord regression analysis. Results: Seven randomized controlled trials (RCTs) with 1264 participants undergoing ERCP were included, and all included studies were conducted in China, with participants representing the Chinese population. The meta-analysis showed that compared to propofol, ciprofol reduced bradycardia (risk ratio [RR] 0.44, 95% confidence interval [CI] 0.26‒0.76, P = 0.003, n = 4), hypotension (RR 0.72, 95% CI 0.55‒0.95, P = 0.02, n = 4), respiratory depression (RR 0.25, 95% CI 0.14‒0.44, P < 0.00001, n = 5), hypoxemia (RR 0.35, 95% CI 0.21‒0.58, P < 0.0001, n = 5), and injection pain (RR 0.17, 95% CI 0.11‒0.26, P < 0.00001, n = 7), but had no significant effect on choking cough, involuntary movements, or nausea and vomiting. TSA showed a conclusive benefit for bradycardia, respiratory depression, hypoxemia, and injection pain, whereas the benefit for hypotension needs further validation. Harbord regression analysis showed no publication bias for any of the outcomes, except for hypotension. Conclusion: Ciprofol has been shown to reduce the incidence of bradycardia, respiratory depression, hypoxemia, and injection pain compared to propofol; however, its impact on the incidence of hypotension requires further evaluation. Future studies are needed to determine the safety, efficacy, and optimal dosing of ciprofol in diverse patient populations, including those with complex comorbidities.