Unsedated colonoscopy: patient characteristics and satisfaction in a community-based endoscopy unit

BackgroundPatients who have a colonoscopy performed in the United States are usually given moderate to deep sedation.ObjectiveWe report our prospective experience with patients willing to have colonoscopy performed without analgesia or sedation.DesignFrom June 6, 2006, to December 7, 2006, a total of 2091 patients underwent colonoscopy in our ambulatory endoscopy unit and were offered their procedure with sedation or no sedation.SettingSingle-center outpatient ambulatory surgery unit.PatientsConsecutive patients who had colonoscopy in our outpatient unit, excluding those who had combined-procedure EGD and colonoscopy.InterventionsPatients who elected to start colonoscopy without medications could request medication at any point during the procedure. Those who requested medication received narcotics or benzodiazepines.Main Outcomes MeasurementsTime to cecum, extent of examination, pain level experienced, and willingness to have the procedure with the same, more, or less medication in the future were evaluated.ResultsA total of 578 patients (27.6%) chose to start without sedation; 470 of those (81.1%, 95% CI, 77.9%-89.3%) completed the examination without medication, 353 men (85%, 95% CI, 84.0%-90.5%) and 117 women (67%, 95% CI, 59.6%-73.4%). Cecal intubation was 1501 of 1512 (99.3%, 95% CI, 98.7%-99.6%) for medicated, 467 of 470 (99.4%, 95% CI, 98.1%-99.8%) for unsedated, and 107 of 108 (99.1%, 95% CI, 93.5%-99.5%) for those who were medicated during the procedure. A total of 458 of the 470 unsedated patients (97.4%, 95% CI, 95.6%-98.5%) were satisfied with their comfort level during the procedure and are willing to have their next colonoscopies without sedation.LimitationsThe study is not randomized or blinded.ConclusionsColonoscopy without sedation is feasible, effective, and well tolerated in a typical U. S. population.