Sedated vs unsedated colonoscopy: A prospective study

Table 1 Pain and satisfaction scores

Pain and satisfaction scores
Doctor’s assessment of the patient’s discomfort level
5	Patient complained bitterly; asked to stop multiple times; numerous delays; pain very distracting for doctor
4	Patient complained multiple times; asked to stop; several delays; would not allow repeat examination with this level of discomfort
3	Few transient delays; overall pain reasonable; doctor would be comfortable repeating examination with this pain level
2	Minor transient pain on insertion only or withdrawal only; patient would do very well with a repeat examination with this level of sedation
1	No pain
Overall level of satisfaction with colonoscopy
	Very satisfied with examination
	Somewhat satisfied with examination
	Somewhat unsatisfied with examination
	Very unsatisfied with examination

Table 2 Patient characteristics n (%)

Characteristics	Sedated	Unsedated	P value
Total	270	133
Male	149 (55.2)	88 (66.2)	0.04
Female	121 (44.8)	45 (33.8)
Average age (yr)	43.4 ± 17	48.4 ± 13.7	0.002
Outpatient	180 (66.7)	119 (89.5)	0.001
Weight (kg)	70.2 ± 18.2	77.9 ± 16.7	0.0004
Smoking	25 (9.3)	12 (9.1)	0.72
NSIADs use	50 (18.7)	20 (15)	0.4
Education level
Less than high school	111 (41.1)	63 (47.4)	0.67
High school	44 (16.3)	22 (16.5)
Some college	36 (13.3)	14 (10.5)
College or more	70 (25.9)	32 (24.1)
Physicians	9 (3.3)	2 (1.5)
Abdominal pain	139 (51.5)	74 (55.6)	0.45
IBS	67 (24.8)	47 (35.3)	0.03
IBD	23 (8.5)	12 (9.1)	0.85
Previous pelvic surgery	35 (13)	29 (22)	0.03
Previous abdominal surgery	65 (24.1)	39 (29.3)	0.28
Anxiety level prior to colonoscopy	6.1 ± 3.7	5.2 ± 3.6	0.008
Previous sedated colonoscopy	50 (18.5)	11 (8.3)	0.0003
Previous sedated gastroscopy	55 (20.4)	8 (6)	0.0001
Preparation quality
Good	139 (50.2)	64 (48.1)	0.72
Fair	92 (34.1)	51 (38.3)
Poor	39 (14.1)	18 (13.5)

Data are frequency counts (percentage of total) or mean ± SD. IBS: Irritable bowel syndrome; IBD: Inflammatory bowel disease.

Table 3 Procedure outcomes n (%)

Outcomes	Sedated(n = 270)	Unsedated(n =133)	P value
Completed	232 (85.9)	112 (84.2)	0.66
TI intubation	97 (35.9)	31 (23.3)	0.01
Findings
Normal	126	55	0.34
Diverticulosis	14	13	0.09
Ulcerative colitis	18	9	1.00
Crohn’s disease	22	1	0.001
Polyps	36	21	0.54
Tumor	16	3	0.13
Incomplete endoscopy reason
Poor preparation	7	4	0.76
Pain	12	12	0.077
Technical difficulty	6	4	0.74
Obstruction	7	1	0.28
Others	6	0	0.18
Time to cecum (min)	12.2 ± 9.4	11.8 ± 8.8	0.68
Total time until discharge	83 ± 58	20.7 ± 21.8	< 0.0001
Average technical ease	8 ± 1.8	7.9 ± 2	0.45
Polypectomy	4	3	0.63
Complications
Oxygen desaturation	4 (1.5)	0	NA

Data are frequency counts (percentage of total) or the mean ± SD. CD: Crohn’s disease; TI: Terminal ileum; UC: Ulcerative colitis; NA: Not applicable.

Table 4 Pain score and anxiety level comparisons n (%)

Pain score and anxiety level	Sedated(n = 270)	Unsedated(n =133)	P value
Average pain score by the patient	3.4 ± 3.4	5.7 ± 3.2	< 0.0001
Average pain score via physician assessment	3.3 ± 2.5	4.1 ± 3	0.007
Average patient satisfaction score	8.8 ± 2.2	7.7 ± 2.6	< 0.0001
Patient satisfaction
Very satisfied	221 (81.9)	88 (66.2)	0.0007
Somewhat satisfied	36 (13.3)	27 (20.3)	0.08
Somewhat unsatisfied	5 (1.9)	7 (5.3)	0.07
Unsatisfied	8 (2.9)	11 (8.3)	0.02
Physician assessment of the patient discomfort level
No pain	56 (20.8)	15 (11.3)	0.02
Minor transient pain	133 (49.4)	74 (55.6)	0.24
Few transient pain	46 (17.1)	19 (14.3)	0.56
Complained multiple times	28 (10.4)	16 (12)	0.01
Complained bitterly	6 (2.2)	9 (6.8)	0.007
Could not recall the procedure	124 (45.9)	51 (3.8)	< 0.0001
Patients willing to repeat the procedure	225 (83.3)	103 (78.6)	0.16
Average physician satisfaction	8.4	7.8 ± 1.9	0.001

Data are frequency counts (percentage of total) or mean ± SD.

¹All received sedation.

Table 5 Univariate analysis of potential predictors of the willingness to repeat the colonoscopy

Variable	Odds ratio	P value	95%CI
Age	1.02	0.04	1.00-1.04
Gender (female)	0.44	0.002	0.26-0.74
Anxiety	0.85	0.003	0.79-0.92
Patient satisfaction score	1.43	0.0001	1.29-1.59
Physician satisfaction score	1.20	0.004	1.06-1.38
Prior pelvic surgery	0.45	0.01	0.25-0.83
Physician assessment of pain	0.84	0.001	0.77-0.92
Education level: college or more	3.04	0.003	1.45-6.37
Patient pain score	0.84	0.0001	0.78-0.90
Time to cecum	1.00	0.92	0.97-1.02
Ability to recall the procedure	0.82	0.49	0.47-1.40
Discharge time	1.00	0.20	0.99-1.00
Abdominal pain	0.78	0.35	0.47-1.31
IBS	0.56	0.03	0.33-0.96
Physician assessment of discomfort level
Complained multiple times	0.16	0.001	0.06-0.46
Complained bitterly	0.11	0.001	0.03-0.39
Technical ease	1.14	0.03	1.01-1.29

IBS: Irritable bowel syndrome.