Ciprofol versus propofol for painless gastrointestinal endoscopy: a dose-stratified systematic review and meta-analysis

Background We compared ciprofol with propofol for painless gastrointestinal endoscopy, focusing on dose, recovery, induction, satisfaction, and adverse events. Methods PubMed and Embase were searched through May 2026 for randomized controlled trials in adults undergoing painless gastrointestinal endoscopy. We pooled weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes using random-effects models. Risk of bias was assessed with the Cochrane tool. The protocol was prospectively registered in PROSPERO (CRD420251088249). Results Eleven trials (2,084 participants) met the criteria. Recovery was statistically longer with ciprofol (WMD 0.83 min, 95% CI 0.16 to 1.49; P = 0.01), but the absolute difference was under 1 min; the difference was observed at 0.4 and 0.5 mg/kg. Induction time and physician and patient satisfaction did not differ significantly. Ciprofol was associated with fewer reported episodes of hypotension (RR 0.81, 95% CI 0.72–0.90), injection pain (RR 0.13, 95% CI 0.08–0.22), respiratory depression (RR 0.47, 95% CI 0.27–0.83), and hypoxemia (RR 0.64, 95% CI 0.42–0.96). Conclusion Ciprofol and propofol produced broadly comparable procedural outcomes. The apparent advantages for selected adverse events and the dose-related recovery pattern are uncertain because all trials were conducted in China, several pooled outcomes were highly heterogeneous, outcome definitions varied, and publication bias was possible. The dose-stratified findings are exploratory, and the results are hypothesis-generating and require confirmation in larger international trials. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251088249, identifier PROSPERO CRD420251088249.