A prospective evaluation of the feasibility of primary screening with unsedated colonoscopy
Received 6 June 2007; accepted 11 March 2009. published online 29 June 2009.
Background
Colonoscopy is the most effective screening tool for colorectal cancer. In Taiwan, colonoscopy is used much less than sigmoidoscopy for screening because sedation significantly increases the cost and is not readily available, and unsedated colonoscopy is considered to be poorly tolerated. However, unsedated colonoscopy has been shown to be well accepted and may improve the cost-effectiveness and access to colonoscopic screening.
Objectives
To compare the feasibility of unsedated colonoscopy and sigmoidoscopy for primary screening and to analyze factors associated with acceptance of the procedures and need for sedation.
Design
Single center, prospective.
Setting
National Taiwan University Medical Center.
Population and Interventions
A consecutive series of 261 subjects without history of colonoscopy or sigmoidoscopy who underwent unsedated colonoscopy (n = 176) or sigmoidoscopy (n = 85) for primary screening.
Main Outcome Measurements
Pain scores, acceptance, and need for sedation.
Results
No significant differences in pain, acceptance, and need for sedation were found between the colonoscopy and sigmoidoscopy groups. Only 9.6% in the colonoscopy group and 10.1% in the sigmoidoscopy group considered sedation necessary. Multivariate analyses revealed that the examinee's sex and the endoscopist, but not the type of endoscopic examination, were associated with the severity of pain and need for sedation.
Limitations
Nonrandomized study design.
Conclusions
Unsedated colonoscopy for primary screening is well accepted in nine tenths of examinees who accept this option and is similar to sigmoidoscopy in pain, acceptance, and need for sedation. Primary screening with unsedated colonoscopy is feasible, as with sigmoidoscopy.
Current affiliations: Department of Internal Medicine (W.-C.L., H.-M.C., C.-C.C., Y.-C.L., M.-S.W., J.-T.L., H.-P.W.), National Taiwan University Hospital, Department of Internal Medicine (H-P.W.), National Taiwan University Hospital Yun-Lin Branch, National Taiwan University College of Medicine, Taipei, Taiwan, Centre of Biostatistics Consultation (A.S.-H.), Division of Biostatistics (A.S.-H.), Graduate Institute of Biostatistics, College of Public Health, National Taiwan University, Taipei, Taiwan
Reprint requests: Hsiu-Po Wang, MD, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
ABSTRACT