Association of Propofol Versus Midazolam Sedation With Successful Pharyngeal Observation During Upper Gastrointestinal Endoscopy: A Retrospective Study

Objectives Adequate pharyngeal observation during esophagogastroduodenoscopy (EGD) is increasingly recognized as an important component of high‐quality upper gastrointestinal endoscopy. However, visualization may be impaired by gag reflexes and patient movement. The current study evaluated the association between sedation strategy and successful pharyngeal observation during routine EGD. Further, whether this association differs according to operator experience was examined. Methods This retrospective single‐center observational study included consecutive sedated EGD procedures performed between April 2024 and March 2025. Successful pharyngeal observation was defined as the successful identification of predefined pharyngeal and hypopharyngeal anatomical landmarks. Multivariate logistic regression analysis was performed to identify factors independently associated with successful pharyngeal observation. Interaction, sensitivity, and propensity score‐matched analyses were also conducted. Results In total, 444 EGD procedures, including 245 performed under midazolam sedation and 199 under propofol sedation, were analyzed. The propofol group had a significantly higher successful pharyngeal observation rate than the midazolam group (90.0% vs. 79.2%, p = 0.011). In the multivariate analysis, propofol sedation was independently associated with successful pharyngeal observation (odds ratio: 2.18, 95% confidence interval: 1.20–3.96, p = 0.008). Sensitivity analyses excluding biopsy cases and analyses restricted to trainees yielded consistent results. Propensity score‐matched analysis also yielded consistent results. Conclusions Sedation strategy was independently associated with successful pharyngeal observation during routine EGD. Propofol sedation may facilitate a more consistent pharyngeal visualization across operators with varying levels of experience. Trial Registration N/A.