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. 2025 Aug 11:16:1644182.
doi: 10.3389/fphar.2025.1644182. eCollection 2025.

Potential of ciprofol as an alternative to propofol in elderly patients undergoing gastrointestinal endoscopy: a meta-analysis and trial sequential analysis

Yunfeng Yu #  1 , Min Liao  2 , Juan Deng  1 , Xinyu Yang  3 , Yuman Yin  3 , Zhenjie Liu  3 , Guomin Zhang  1
Affiliations

Potential of ciprofol as an alternative to propofol in elderly patients undergoing gastrointestinal endoscopy: a meta-analysis and trial sequential analysis

Yunfeng Yu et al. Front Pharmacol. .

Abstract

Objective: Ciprofol is increasingly being used for sedation and induction of anesthesia in China. However, it remains unclear whether ciprofol is a more appropriate sedative than propofol in gastrointestinal endoscopy, especially in the elderly population. This study aimed to compare the safety of ciprofol with propofol in elderly patients undergoing gastrointestinal endoscopy.

Methods: Eight common databases were used to search the relevant literature up to 1 January 2025. Included studies were screened according to established criteria, and their basic characteristics, outcome data, and risk of bias were recorded. Subsequently, Review Manager 5.3 software was used to perform meta-analysis and Trial Sequential Analysis (TSA) 0.9.5.10 Beta software was used to perform TSA.

Results: Twelve randomized controlled trials and 1,653 participants were included in this study. Meta-analysis showed that compared to propofol, ciprofol reduced the incidence of hypotension (risk ratio [RR] 0.59, 95% confidence interval [CI] 0.48-0.71, P < 0.00001), respiratory depression (RR 0.30, 95% CI 0.20-0.46, P < 0.00001), hypoxemia (RR 0.29, 95% CI 0.20-0.43, P < 0.00001), injection pain (RR 0.15, 95% CI 0.10-0.22, P < 0.00001), involuntary movements (RR 0.70, 95% CI 0.53-0.92, P = 0.01) as well as nausea and vomiting (RR 0.59, 95% CI 0.36-0.96, P = 0.03), while there was no significant effect on induction time, awakening time, bradycardia, and choking cough (P > 0.05). The TSA revealed conclusive differences in hypotension, respiratory depression, hypoxemia, and injection pain. Regression analysis indicated no publication bias for any of the outcomes (P > 0.05) except awakening time (P = 0.007).

Conclusion: These findings suggest that in elderly patients undergoing gastrointestinal endoscopy, ciprofol has fewer cardiovascular, respiratory, and neurological adverse events than propofol, highlighting the potential of ciprofol as an alternative to propofol. However, the optimal dose of ciprofol for gastrointestinal endoscopic sedation in the elderly remains to be explored.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025643465, identifier CRD42025643465.

Keywords: ciprofol; elderly patients; gastrointestinal endoscopy; meta-analysis; propofol.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Graphical abstract.
FIGURE 2
FIGURE 2
Flowchart of literature screening.
FIGURE 3
FIGURE 3
Risk of bias summary.
FIGURE 4
FIGURE 4
Summary of meta-analysis results.
FIGURE 5
FIGURE 5
Forest plots of meta-analysis on time outcomes. (A) Induction time; (B) Awakening time.
FIGURE 6
FIGURE 6
Forest plots of meta-analysis on circulatory system outcomes. (A) Hypotension; (B) Bradycardia.
FIGURE 7
FIGURE 7
Forest plots of meta-analysis on respiratory system outcomes. (A) Respiratory depression; (B) Choking cough; (C) Hypoxemia.
FIGURE 8
FIGURE 8
Forest plots of meta-analysis on nervous and digestive system outcomes. (A) Injection pain; (B) Involuntary movement; (C) Nausea and vomiting.
FIGURE 9
FIGURE 9
Trial sequential analysis results of positive outcomes. (A) Hypotension; (B) Respiratory depression; (C) Hypoxemia; (D) Injection pain; (E) Involuntary movements; (F) Nausea and vomiting.
FIGURE 10
FIGURE 10
Regression analysis results of publication bias. (A) Induction time; (B) Recovery time; (C) Hypotension; (D) Bradycardia; (E) Respiratory depression; (F) Choking cough; (G) Hypoxemia; (H) Injection pain; (I) Involuntary movements; (J) Nausea and vomiting.
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