Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.5113
Revised: January 1, 2014
Accepted: February 20, 2014
Published online: May 7, 2014
AIM: To compare sedated to unsedated colonoscopy in terms of duration, pain and the patient’s willingness to repeat the procedure.
METHODS: Consecutive patients who underwent colonoscopies over a 2-year period were invited to participate. All patients who were to undergo our endoscopy unit were offered sedation with standard intravenous sedatives and analgesics, or an unsedated colonoscopy was attempted. Demographic details were recorded. The patient anxiety level prior to the procedure, time to reach the cecum, total discharge time, patient and endoscopist pain assessments, satisfaction after the examination and the patient’s willingness to return for the same procedure in the future were recorded.
RESULTS: Among the 403 observed patients, more males were observed in the unsedated group (66.2% vs 55.2%, P = 0.04). Additionally, the unsedated group patients were less anxious prior to the procedure (5.1 vs 6.0, P < 0.01). The colonoscopy completion rates were comparable between the 2 groups (85.9% vs 84.2%, P = 0.66). The time to reach the cecum was also comparable (12.2 min vs 11.8 min); however, the total discharge times were shorter in the unsedated group (20.7 min vs 83.0 min, P < 0.01). Moreover, the average patient pain score (3.4 vs 5.7, P < 0.01) was lower in the sedated group, while the satisfaction score (8.8 vs 7.8, P < 0.01) was significantly higher. There was no significant difference, however, between the groups in terms of willingness to repeat the procedure if another was required in the future (83.3% vs 77.3%, P = 0.17).
CONCLUSION: Unsedated colonoscopy is feasible in willing patients. The option saves the endoscopy units up to one hour per patient and does not affect the patient willingness to return to the same physician again for additional colonoscopies if a repeated procedure is needed.
Core tip: Published information indicates that unsedated colonoscopies are acceptable in many countries; however, sedation is still a usual practice in many countries. Its burden includes escort requirement, time for recovery and activity restrictions. This study showed that unsedated colonoscopy is feasible in willing patients and it saves the endoscopy units up to one hour per patient. Contrary to some endoscopist’s fears, patients were still willing to return to the same physician for colonoscopy if a repeat procedure was needed.