• Adenoma detection rate
• Cecal intubation rate
• Colonoscopy
• Outcomes
• Sedation-free
• Unsedated

Colonoscopy is considered to be the most effective tool for reducing colorectal cancer (CRC) morbidity and mortality. As a result, certifying trainee competence in the performance of colonoscopy is critical to maximizing CRC screening and prevention efforts. Guidelines on training and accreditation around the world have been revised to emphasize the attainment of milestones in the technical and cognitive skills necessary to perform the procedure. To meet this challenge, new evaluation systems have been developed to measure trainee competence through all aspects of colonoscopy training. These changes stem from increased recognition that procedural numbers alone do not necessarily guarantee trainees’ proficiency in the performance of colonoscopy. Variability in endoscopic practice and in CRC screening outcomes also point to deficiencies in the current approach towards colonoscopy instruction. However, technological innovations hold great promise in training endoscopists to perform high quality colonoscopy. Furthermore, potential advances in the use of feedback as a training tool provide new avenues for research. This review summarizes the latest evidence on the effort to define, evaluate and promote the achievement of competence in colonoscopy among trainees.

• Competence
• Colonoscopy
• Colorectal cancer
• Core curriculum
• Cecal intubation

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.

• Sedation
• Colonoscopy
• Unsedated
• Screening
• Endoscopy

• Adult
• Colonoscopy/adverse effects
• Feasibility Studies
• Female
• Humans
• Hypnotics and Sedatives/therapeutic use
• Male
• Middle Aged
• Pain/diagnosis
• Pain/etiology
• Pain Measurement
• Patient Satisfaction
• Predictive Value of Tests
• Prospective Studies
• Time Factors

• Adult
• Anesthesia
• Anesthetics, Local
• Colonoscopy/standards
• Conscious Sedation/standards
• Endoscopy, Gastrointestinal/standards
• Humans
• Hypnotics and Sedatives/administration & dosage
• Hypnotics and Sedatives/therapeutic use
• Patient Compliance
• Professional Practice/standards
• Propofol/administration & dosage
• Propofol/therapeutic use

AIM: To compare the clinical costs, safety and comfortableness as well as the satisfaction degree among examinees and examiners between sedated gastrocolonoscopy and conventional gastrocolonoscopy.

METHODS: One thousand and eight hundred patients undergoing gastrocolonoscopy and 11 physicians conducting such examinations at either Zhongnan Hospital of Wuhan University or Wuhan General Hospital of Guangzhou Military Command from March 2009 to September 2009 were enrolled to fill out a questionnaire. Of all patients, 1 000 underwent conventional gastrocolonoscopy, and 800 underwent sedation gastrocolonoscopy.

RESULTS: The two groups of patients had significant differences in occupation, educational background, income level and the source of costs (all P < 0.01). There was no statistical difference in the number of patients intolerant of the examinations between the two groups (P > 0.05). Significant differences were also noted in the comfortableness and safety between the two groups (P < 0.01). Although there was no significant difference in patient's satisfaction degree between the two groups (P > 0.05), the physicians believed that conventional gastrocolonoscopy was safer than sedated gastrocolonoscopy.

CONCLUSION: Conventional gastrocolonoscopy is economic, effective and safe, and is accepted by the majority of patients. Though sedated gastrocolonoscopy is more comfortable and less painful, it has a higher price and risk. Therefore, sedated gastrocolonoscopy is suitable for patients who are unwilling to or cannot undergo conventional endoscopy. Patients who previously underwent colonoscopy prefer to accept sedated examination.

• Sedation gastrocolonoscopy
• Conventional gastrocolonoscopy
• Comparative questionnaire investigation

• Colon cancer screening
• Sedation-risk-free colonoscopy
• Unsedated colonoscopy