Involvement of trainees in routine unsedated colonoscopy: review of a pilot experience

BackgroundUnsedated colonoscopy is not required by the Accreditation Council of Graduate Medical Education in the curriculum of GI trainees.ObjectiveWe describe our pilot experience with trainee participation in unsedated colonoscopy.DesignA retrospective review of a performance improvement program to provide access to colonoscopy.SettingA Veteran's Affair ambulatory care facility that discontinued sedated colonoscopy because of a nursing shortage.PatientsA total of 145 of 483 patients who chose unsedated colonoscopy after both sedated and unsedated options were discussed.InterventionsGI fellows performed unsedated colonoscopy under the supervision of the attending physician.Main Outcome MeasurementsCecal intubation rate, patient assessment of the reasons for the choice, the unsedated experience, willingness to have another colonoscopy, and the rate of return for unsedated colonoscopy among eligible patients.ResultsCecal intubation was achieved in 112 of 145 patients. The adjusted success rate (excluding inadequate bowel preparation and an obstructing lesion) was 81%. The most frequently acknowledged reason for the choice was the ability to communicate with the colonoscopist. Eighty-six patients reported a good experience and were likely to accept another unsedated colonoscopy. To date, all 8 patients eligible for 3-year follow-up successfully completed another unsedated examination.LimitationAn uncontrolled, nonrandomized review in predominantly male older veterans.ConclusionsAn unsedated colonoscopy might be acceptable to some populations, particularly when communication with clinicians and procedural convenience are highly valued. Involvement of trainees is feasible. Randomized controlled comparisons of sedated and unsedated options in terms of safety (eg, sedation and procedure-related complications) and cost in settings with and without a nursing shortage deserve to be considered.