Options for screening colonoscopy without sedation: sequel to a pilot study in U.S. veterans

BackgroundSedation on demand combined with a novel water infusion technique enabled 23 of 44 veterans to complete screening colonoscopy without sedation.ObjectiveWith use of the usual air insufflation technique, we determined the proportion of patients who could complete colonoscopy without sedation.DesignRetrospective review of prospectively collected data in a performance improvement project to minimize the burden of sedation.SettingA Veterans Affairs open access screening colonoscopy program.SubjectsNinety-three consecutive veterans who accepted on-demand sedation or scheduled no sedation.MethodUsual air insufflation during colonoscope insertion. Medications were administered at the veteran's request.ResultsTwenty-three veterans chose scheduled unsedated colonoscopy; 22 were completed without sedation. Sedation on demand enabled 54 to complete the procedure without medications; 16 requested medications to complete colonoscopy. Nurses' expectations indicated that the choices were credible options.ConclusionsOptions for screening colonoscopy without sedation combined with usual air insufflation are feasible among U.S. veterans. Confirmation by randomized controlled trial and evaluation of the impact on institutional costs and patient adherence to screening and surveillance colonoscopy deserve to be considered.