Document Detail


Unsedated colonoscopy: an option for some but not for all.
MedLine Citation:
PMID:  22248607     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The increasing request for colonoscopy in clinical practice, coupled with the lack of time, has led to a renewed interest in unsedated procedures.
OBJECTIVE: To evaluate the acceptability of unsedated colonoscopy and to characterize the subset of patients more likely to undergo and complete the procedure without sedation and/or analgesia.
DESIGN: Prospective, population study.
SETTING: Nonacademic community hospital, 6-month observation period.
PATIENTS: Adult outpatients referred for colonoscopy were offered unsedated procedure, with the possibility of on-demand sedation.
INTERVENTIONS: Demographics, clinical features, and endoscopy outcomes were recorded. Data were analyzed by stepwise logistic regression analysis, and odds ratio (OR) and 95% confidence interval (CI) are given for significant variables.
MAIN OUTCOME MEASUREMENTS: Unsedated colonoscopy acceptance rate. Factors significantly associated with acceptance and completion of unsedated procedures.
RESULTS: The acceptance rate for unsedated colonoscopy was 56.2% of 964 consecutive evaluated patients. The cecal intubation rate in unsedated patients was 81.6% and increased to 97.3% with the option of on-demand sedation. At multivariate analysis, factors significantly associated with the acceptance were no previous colonoscopy (OR 1.52; 95% CI, 1.10-2.11), absent/low level of anxiety (OR 3.82; 95% CI, 2.71-5.38), and no concern about the examination (OR 1.80; 95% CI, 1.17-2.77). Fear of procedure-related pain was inversely associated with acceptance (OR 0.28; 95% CI, 0.17-0.35). Factors associated to drug-free colonoscopy completion were absence of preprocedure anxiety (OR 1.87; 95% CI, 1.08-3.21) and male sex (OR 3.59; 95% CI, 2.13-6.05).
LIMITATIONS: Single-center study.
CONCLUSION: The acceptance rate of unsedated colonoscopy is clinically relevant, and the procedure can be completed without sedation in the majority of patients. Subject-related factors may help to identify patients willing to undergo and potentially complete unsedated procedures.
Authors:
Silvia Paggi; Franco Radaelli; Arnaldo Amato; Gianmichele Meucci; Giancarlo Spinzi; Emanuele Rondonotti; Vittorio Terruzzi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  75     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-17     Completed Date:  2012-05-25     Revised Date:  2012-10-12    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  392-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Affiliation:
Gastroenterology Unit, Valduce Hospital, Como, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anxiety / psychology
Colonoscopy / methods*,  psychology
Confidence Intervals
Deep Sedation*
Fear / psychology
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Patient Acceptance of Health Care / psychology,  statistics & numerical data*
Patient Satisfaction / statistics & numerical data*
Prospective Studies
Sex Factors
Comments/Corrections
Comment In:
Gastrointest Endosc. 2012 Sep;76(3):699; author reply 699   [PMID:  22898428 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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