Evidence to suggest adoption of water exchange deservesbroader consideration:Its pain alleviating impact occurs in90%of investigators

AIM: To determine variations in colonoscopy real-time insertion pain among investigators using three different insertion techniques.METHODS: From March 2013 through June 2014, 18-85-year-old diagnostic and 50-70-year-old screening patients were enrolled at each center to on-demand sedation colonoscopy with water exchange(WE), water immersion(WI) and insufflation with air or CO2 for insertion and withdrawal [air or carbon dioxide(AICD)]. Data were aggregated for analysis. Primary outcome: Variations in real-time maximum insertion pain(0 = none, 1-2 = discomfort, 10 = worst).RESULTS: One thousand and ninety-one cases analyzed: WE(n = 371); WI(n = 338); AICD(n = 382). Demographics and indications were comparable. The WE group had the lowest real-time maximum insertion pain score, mean(95%CI): WE 2.8(2.6-3.0), WI 3.8(3.5-4.1) and AICD 4.4(4.1-4.7), P < 0.0005. Ninety percent of the colonoscopists were able to use water exchange to significantly decrease maximum insertion pain scores. One investigator had high insertion pain in all groups, nonetheless WE achieved the lowest real-time maximum insertion pain score. WE had the highest proportions of patients with painless unsedated colonoscopy(vs WI, P = 0.013; vs AICD, P < 0.0005); unsedated colonoscopy with only minor discomfort(vs AICD, P < 0.0005), and completion without sedation(vs AICD, P < 0.0005).CONCLUSION: Aggregate data confirm superiority of WE in lowering colonoscopy real-time maximum insertion pain and need for sedation. Ninety percent of investigators were able to use water exchange to significantly decrease maximum insertion pain scores. Our results suggest that the technique deserves consideration in a broader scale.

Sedated vs unsedated colonoscopy:A prospective study

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(5.1vs 6.0,P<0.01).The colonoscopy completion rates were comparable between the 2 groups(85.9%vs84.2%,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-risk-free colonoscopy for minimizing the burden of colorectal cancer screening

Unsedated colonoscopy is available worldwide,but is not a routine option in the United States(US).We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the use of unsedated colonoscopy for colorectal cancer screening.Medline data from 1966 to 2009 were searched to identify relevant articles on the subject.Data were summarized and co-authors provided critiques as well as accounts of unsedated colonoscopy for screening and surveillance.Diagnostic colonoscopy was initially dev eloped as an unsedated procedure.Procedure-re lated discomfort led to wide adoption of sedation in the US,although unsedated colonoscopy remains the usual practice elsewhere.The increased use of colonoscopy for colorectal cancer screening in healthy,asymptomatic individuals suggests a reass-essment of the burden of sedation in colonoscopy for screening is appropriate in the US for lowering costs and minimizing complications for patients.A water method developed to minimize discomfort has shown promise to enhance outcomes of unsedated colonoscopy.The use of scheduled,unsedated colono scopy in the US appears to be feasible for colorectal cancer screening.Studies to assess its applicability in diverse practice settings deserve to be conducted and supported.