Colonoscopy without sedation has several advantages over sedated colonoscopy, but a considerable proportion of patients experience pain.
Dr Yvind Holme and colleagues from Norway developed a risk stratification model of pre-examination risk factors to enable targeted sedation during colonoscopy.
The research team prospectively recruited consecutive outpatients who were willing to start colonoscopy without sedation at 11 Norwegian centers, between 2011 and 2012.
|3% of women with 3 risk factors experienced a painful colonoscopy|
Patients recorded pain on a validated 4-point scale.
Potential risk factors for a painful procedure were evaluated using multivariate logistic regression analyses, and the area under the receiver operating characteristics curve was calculated to assess the discriminatory ability of the derived model.
A total of 1198 patients were included.
The doctors identified 7 independent, pre-procedural risk factors for patient pain, including female sex, age under 40 years, previous abdominal surgery, abdominal pain as indication for colonoscopy, anticipation of pain, previous painful colonoscopy, and a history of diverticulitis.
The team observed that In patients with 0, 1, 2, or 3 risk factors, a painful colonoscopy was experienced by 35%, 43%, 52%, and 63% of women, and 18%, 24%, 35%, and 63% of men, respectively.
The model showed modest discrimination abilities.
Dr Holme's team commented, "Female sex was a strong risk factor for pain during colonoscopy, and sedation or analgesia should be considered for all women prior to colonoscopy."
"For male patients, the presence of multiple risk factors should encourage the endoscopist to offer sedation."