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Structured Approach to Colonoscopy Technique Optimization: A Single-Center Experience with Novice Endoscopists
Published on: July 11, 2025
Unsedated colonoscopy: time to revisit this option?
Felix W Leung1, Steven Aharonian, Paul H Guth
1Division of Gastroenterology, Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System, North Hills, CA 91343, USA. felix.leung@va.gov
The Journal of Family Practice
|December 17, 2008
Summary
Supervised trainees can perform unsedated colonoscopies, making this life-saving screening accessible by reducing costs and eliminating sedation risks. This approach offers a feasible alternative for colorectal cancer screening.
Area of Science:
- Gastroenterology
- Medical Education
- Public Health
Background:
- High sedation costs limit access to colonoscopy screening.
- A Veterans Administration program faced a nursing shortage, impacting sedated colonoscopy services.
- Unsedated colonoscopy was explored as a solution to restore screening access.
Purpose of the Study:
- To evaluate the feasibility of supervised trainees performing unsedated colonoscopies.
- To assess the practicability of offering colonoscopy without sedation.
- To determine if unsedated colonoscopy could overcome access barriers.
Main Methods:
- Second-year gastroenterology fellows performed unsedated colonoscopies.
- Patients were offered an unsedated option due to service discontinuation.
- Trainees had prior experience with approximately 100 sedated colonoscopies.
Main Results:
- 145 out of 483 patients opted for the unsedated procedure.
- Cecal intubation was successful in 81% of patients with adequate bowel preparation.
- The unsedated approach eliminated the need for extra nursing staff, escorts, and post-procedure restrictions, alongside sedation complications.
Conclusions:
- Unsedated colonoscopy performed by supervised trainees is feasible.
- This method reduces both direct and indirect costs associated with colonoscopy.
- Promoting unsedated colonoscopy as "sedation risk-free" can encourage patient acceptance and potentially reshape screening practices.
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