Predicting patient tolerance of endoscopy with conscious sedation

To evaluate the adequacy of benzodiazepine/opiate sedation for endoscopic procedures and to identify patient and procedure characteristics that may predict poor procedural tolerance.

A total of 2155 patients who underwent sedated gastroscopy, colonoscopy or flexible sigmoidoscopy between January and December 2007, participated in the prospective evaluation of procedural tolerance and the procedures were evaluated using three questionnaires completed by the patient, endoscopist and assisting nurse. Perception of procedural tolerance was scored using a 100-point visual analog scale (VAS), 0: very good to 100: very poorly. In order to identify patient and procedure characteristics predictive of poor procedural tolerance, we compared 10% of patients who tolerated the procedure least well with the remaining patients.

About 216 (10%) of 2155 patients gave a VAS score of >30, and were compared with the 1939 patients with a VAS <30. Patients who tolerated the procedure least well (VAS ≥30) were more likely female [odds ratio (OR) 2.8, 95% confidence interval 1.9-4.1], had colonoscopy (OR 2.9, 1.8-4.5) or had a training endoscopist perform the procedure (OR 3.2, 2.2-4.8). Patients with BMI ≥35 were also more likely to have a VAS ≥30 (p < 0.01). Sedation type and American Society of Anesthesiologists grade had no significant effect on patient tolerance.

A majority of patients tolerate endoscopic procedures well when benzodiazepine/opiate sedation is used. Accurately identifying the minority who tolerate these procedures less well remains difficult.