Contrary to the belief that sedation is needed for comfort during colonoscopy procedures, a study had shown that unsedated colonoscopy is well accepted by patients.

According to background information provided by the authors, the advantages of unsedated colonoscopy include the elimination of the risks associated with sedation; a reduction in the recovery time after the procedure; a decrease in the need for cardiopulmonary monitoring; and a significant reduction in cost.

To demonstrate the tolerability of screening methods for colorectal cancer, researchers compared unsedated colonoscopy with sigmoidoscopy, an exam that evaluates only about one-third of the colon, compared to a colonoscopy which examines the entire colon. “When choosing between unsedated colonoscopy and sigmoidoscopy for screening, most patients undergo sigmoidoscopy because the majority of doctors and patients consider unsedated colonoscopy to be poorly accepted,” said lead author Hsiu-Po Wang, MD, from the National Taiwan University Hospital.

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Included in the study were patients who had not undergone previous sigmoidoscopy or colonoscopy. When asked if they wanted to undergo either a sigmoidoscopy or colonoscopy without sedation, of the 261 patients, 176 selected colonoscopy and 85 selected sigmoidoscopy. A trained nurse, who was blinded to the type of procedure a patient underwent, evaluated the severity of pain, acceptance of the procedure, and the need for sedation immediately after the examination.

Among patients surveyed after unsedated colonoscopy or sigmoidoscopy, approximately 90% reported they did not feel sedation was necessary for the examination. Only 9.4% of patients in the sigmoidoscopy group and 10.8% of patients in the colonoscopy group considered sedation necessary for the procedure.

Furthermore, no significant differences were observed in pain, acceptance, need for sedation, and the rate of complete examination between patients undergoing unsedated colonoscopy and sigmoidoscopy.

The authors concluded that primary colorectal cancer screening with unsedated colonoscopy is feasible and may be the first-choice strategy in most Asian countries because it is more effective and may save money and time compared with sigmoidoscopy.

The study was published in GIE: Gastrointestinal Endoscopy (2009;70[4]:724-731).