Unsedated Colonoscopy: Experience from an Endoscopy Centre

Aim and Objective: Colonoscopy is generally considered a painful procedure requiring sedation. Due to the high cost of sedation colonoscopy, coupled with the attendant morbidity and mortality, there is a general trend towards unsedated colonoscopy. The aim of this study was to determine the effect of unsedated colonoscopy on the success of caecal intubation, factors predictive of painful procedure and to compare with results elsewhere.
Materials and Methods: Forty one consecutive patients who underwent colonoscopy were recruited into this study. The study was carried out at a privately owned low-volume endoscopy centre: Gilead specialist hospital (GSH), Ado-Ekiti, Nigeria from January 2010 to December 2011. Ethical approval for the study was obtained from the centre’s Research and Ethics Committee and all the patients gave their individual written consent. SPSS version 15.0 (SPSS, Inc., Chicago, Illinois, USA) was deployed for statistical analysis using the t-test for quantitative variables and χ2 test for qualitative variables. Differences were considered to be statistically significant if P value was less than 0.05.
Results: The male: female ratio was 1.93:1. The mean age of the studied population was 53.20±9.53 years [age range from 30-71. The indications for colonoscopy were; lower gastrointestinal bleeding (41.5%), abdominal pain or discomfort (19.5%), diarrhea (12.2%), suspected cancer [Patients with history of GI bleeds, weight loss, recurrent diarrhoea and ileus (12.2%), constipation (7.3%) and routine examination (7.3%). Overall, caecal intubation was achieved in 70.7% of cases while in 29.3% caecal intubation was unsuccessful. With on demand analgesia, and exclusion of both cases of obstruction (tumors) and poor bowel preparations, caecal intubation rate rose to 94.3%. Causes of unsuccessful caecal intubation included: abdominal pain or discomfort (33.3%), bowel obstruction (25%), poor bowel preparation (16.7%), anxiety (6.6%) and obesity (8.3%). Colonoscopy findings were haemorrhoids (36.6%), polyps (17.1%), colorectal cancer (14.6%), arteriovenous malformations (7.3%), anal fissure (4.9%), inflammatory bowel disease (2.4%) and normal findings (17.1%). Bowel preparation was adjudged adequate in 80.5% (33/41) of the patients. Female gender and abdominal pain as indication for colonoscopy were found to be predictive for painful colonoscopy (p<0.05).
Conclusion: Unsedated colonoscopy with on demand analgesia is advocated in resource poor countries to minimize the direct and indirect costs of colonoscopy. It is also recommended to minimize patient burden in screening and surveillance colonoscopy. Colonoscopists are advised to use the warm water (37°C) method in this setting as against the traditional air insufflations to achieve a high success rate of caecal intubation.