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Sedation practice and comfort during colonoscopy: lessons learnt from a national screening programme

Ball, Alex J.; Rees, Colin J.; Corfe, Bernard M.; Riley, Stuart A.

European Journal of Gastroenterology & Hepatology: June 2015 - Volume 27 - Issue 6 - p 741–746
doi: 10.1097/MEG.0000000000000360
Original Articles: Colorectal Cancer Screening

Aim: Medication may be used to manage discomfort during colonoscopy but practice varies. The relationship between medication use and comfort during colonoscopy was examined in the English Bowel Cancer Screening Programme.

Methods: Data related to patient comfort and medication use from all 113 316 examinations performed within the English Bowel Cancer Screening Programme between 1 January 2010 and 31 December 2012 were analysed. Comfort was rated on the five-point Modified Gloucester Comfort Scale: 1, no discomfort; 5, severe discomfort. Scores of 4 and 5 were considered to indicate significant discomfort. Correlations between the proportion of examinations associated with significant discomfort and the amounts of medication used by colonoscopists were assessed using Spearman’s ρ. Logistic regression modelling examined the independent predictors of significant discomfort.

Results: Patients had a mean age of 65.7 years, and 58% were male. Examinations were performed by 290 endoscopists. In 91% of examinations, there was no significant discomfort reported during examination; however, there was considerable variation between individual colonoscopists (range 76.1–99.2%).

Intravenous sedation and opiate analgesia were used during most examinations, but there was wide variation between colonoscopists, with a median (range) usage of 95.1% (4.1–100%) and 97.3% (5.6–100%), respectively. There was no association between the amount of sedation and analgesia used and significant discomfort (ρ<0.2). On multivariate analysis, significant discomfort was found to be more common among female individuals [odds ratio (OR)=2.0], on incomplete examinations (OR=6.7), and among patients with diverticulosis (OR=1.4).

Conclusion: There was wide variation in medication practice among English screening colonoscopists, but this was unrelated to the occurrence of significant discomfort.

aDepartment of Gastroenterology, Sheffield Teaching Hospitals

bDepartment of Oncology, University of Sheffield, Medical School

cSouth Yorkshire and Bassetlaw Bowel Cancer Screening Centre, Sheffield Teaching Hospitals, Sheffield

dSouth of Tyne Bowel Cancer Screening Centre, South Tyneside General Hospital, South Shields

eDurham University School of Medicine, Pharmacy and Health, Durham, UK

Correspondence to Alex J. Ball, MBChB (Hons), Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield S5 7AU, UK Tel: +44 114 243 4343; fax: +44 114 226 6064; e-mail: alex.ball@sth.nhs.uk

Received January 12, 2015

Accepted March 5, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.