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

Background: Patients who have a colonoscopy performed in the United States are usually given moderate to deep sedation. Objective: We report our prospective experience with patients willing to have colonoscopy performed without analgesia or sedation. Design: From 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. Setting: Single-center outpatient ambulatory surgery unit. Patients: Consecutive patients who had colonoscopy in our outpatient unit, excluding those who had combined-procedure EGD and colonoscopy. Interventions: Patients 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 Measurements: Time 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. Results: A 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. Limitations: The study is not randomized or blinded. Conclusions: Colonoscopy without sedation is feasible, effective, and well tolerated in a typical U. S. population. [Copyright &y& Elsevier]