Review for 10.1186/s12876-025-03734-0 (2025)

Title: Safety and efficacy of ciprofol versus propofol for gastrointestinal endoscopy: a meta-
analysis
Version: 1 Date: 05 Jan 2025
Reviewer's report:
This manuscript presents a well-structured methodology for conducting a systematic review
and meta-analysis to compare ciprofol and propofol in the context of painless gastrointestinal
endoscopy. Below is a detailed commentary on various aspects of the manuscript:
Strengths:
Comprehensive Search Strategy:
The inclusion of multiple reputable databases (PubMed, Embase, Cochrane, CNKI, WanFang,
VIP) is a significant strength. This wide coverage ensures that relevant studies from different
regions and disciplines are considered, minimizing publication bias.
The search terms are appropriately selected, covering both drugs (ciprofol and propofol) and
the procedures (gastrointestinal endoscopy, colonoscopy, and gastroscopy), making the search
exhaustive.
Clear Inclusion and Exclusion Criteria:
The inclusion criteria are well-defined, ensuring the selection of RCTs with valid data.
Specifically, the requirement that the test and control groups use only ciprofol and propofol
ensures a focused comparison.
The exclusion criteria are thorough, addressing various study types and methodological flaws
(e.g., non-RCTs, unpublished studies), which helps ensure the reliability of the results.
Objective Outcome Measures:
The focus on sedation effectiveness, major ADRs, and anesthesia-related time indicators is
appropriate for this type of comparison. These are clinically relevant and will provide valuable
information on both drugs' safety and efficacy.
The sedation effectiveness definition is practical, emphasizing the success of the procedure
and the requirement for minimal additional sedation, which is a useful measure of clinical
effectiveness.
Bias Risk Assessment:
The use of a risk of bias assessment tool (with categories like random sequence generation,
allocation concealment, blinding, etc.) ensures that the included studies are of high
methodological quality.
By categorizing studies based on their risk of bias (low, unclear, or high), the manuscript
acknowledges potential study weaknesses, which adds transparency and rigor to the analysis.
Robust Statistical Analysis:
The detailed statistical methods, including the use of fixed or random effects models depending
on heterogeneity, are well-considered and follow accepted guidelines for meta-analysis.
The inclusion of publication bias assessment through funnel plots and Egger’s test is crucial in
ensuring that the results are not influenced by small-study effects.
The significance level of P < 0.05 and the use of sensitivity analysis further ensure the reliability
of the findings.
Transparent and Reproducible Process:
The method of independent literature screening and data extraction by two researchers adds
rigor and reduces the potential for bias. The cross-checking process between researchers ensures
consistency and accuracy.
Areas for Improvement:
Clarity on the Definition of "Sedation Effectiveness":
While sedation effectiveness is clearly defined, it may be useful to expand on the exact
criteria for defining "successful completion" of the gastrointestinal endoscopy. Are there any
specific measures of procedure success beyond the need for additional sedation (e.g., procedural
complications or patient comfort)? This could help clarify the outcome measure further.
Consideration of Adverse Drug Reactions (ADRs):
The manuscript mentions major ADRs such as hypotension, bradycardia, injection pain, and
respiratory depression but does not detail the method for categorizing the severity or incidence
of these ADRs. Providing more specific criteria or guidance on how ADRs will be assessed and
reported would be helpful for readers.
It would be beneficial to specify whether the ADRs are to be classified as minor or major, and
how these would be weighted in the analysis.
Language Considerations:
The inclusion of literature published in languages other than Chinese and English is excluded.
While this decision helps maintain a manageable scope, it may introduce bias by excluding
studies published in other languages (e.g., European languages). Expanding the language
inclusion criteria or discussing the potential impact of this limitation on generalizability would
be useful.
External Validity of Results:
While the inclusion criteria are comprehensive, the lack of any specific mention of underlying
patient characteristics (e.g., age-related comorbidities or previous sedation history) may affect
the generalizability of the results to specific subpopulations. Including or discussing these
potential factors might provide a more nuanced understanding of the drugs' effectiveness in
varied patient groups.
Potential Limitations in Handling Heterogeneity:
The manuscript appropriately plans to use a random-effects model in cases of high heterogeneity,
but further discussion of potential causes for heterogeneity would be valuable. For example,
differences in study populations, dosages, or the type of gastrointestinal procedure could
introduce variability. A sensitivity analysis that investigates these factors might provide more
clarity.