Colonoscopy without sedation

PURPOSE AND METHODS: Two hundred fifty-eight consecutive nonsedated colonoscopies were prospectively evaluated over an 18-month period. The cecum was intubated in 250 cases (97 percent). Polypectomies or biopsies were performed in 77 cases (31 percent). Indications for colonoscopy included history of polyps (32 percent), hematochezia (28 percent), family history of colon cancer (16 percent), prior history of colon cancer (9 percent), change in bowel habits (12 percent), abnormal flexible sigmoidoscopy (6 percent), and inflammatory bowel disease (3 percent). RESULTS: Sedation was withheld for the following reasons: patient preference (57 percent), medical problems (2 percent), prior resection (16 percent), surgeon preference (6.5 percent), lack of intravenous access (3 percent), and age (1 percent). Three patients (1.5 percent) required sedation to complete the procedure. Procedure-related pain was based on a scale from zero to three. One hundred thirtynine patients (61 percent) rated their pain as either zero (no pain) or one (mild pain), and 217 percent (8 percent) indicated that they would prefer their next colonoscopy to be performed without sedation. One hundred twelve patients had previously undergone sedated colonoscopy. Ninety-two (92 percent) preferred nonsedated to sedated procedures. Average procedure time was 13.7 (range, 0.5 to 85) minutes. CONCLUSIONS: Several series have studied nonsedated endoscopic upper and lower gastrointestinal evaluations. None, however, have evaluated patient comfort and satisfaction. In our prospective series of 258 consecutive nonsedated colonoscopies, we found the procedure to be safe, effective, and well accepted.