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

Area of Science:

• Gastroenterology
• Clinical Practice Guidelines
• Patient Outcomes

Background:

• Medication use during colonoscopy for discomfort management is common but lacks standardized practice.
• Variability in medication protocols among endoscopists performing colonoscopies has been observed.

Purpose of the Study:

• To investigate the relationship between medication administration and patient comfort during colonoscopies.
• To analyze medication use patterns and their correlation with reported discomfort in the English Bowel Cancer Screening Programme.

Main Methods:

• Analysis of data from 113,316 colonoscopies in the English Bowel Cancer Screening Programme (2010-2012).
• Patient comfort assessed using the Modified Gloucester Comfort Scale; significant discomfort defined as scores of 4 or 5.
• Statistical analysis included Spearman's rank correlation and logistic regression to identify predictors of discomfort.

Main Results:

• No association was found between the quantity of intravenous sedation and opiate analgesia administered and the occurrence of significant patient discomfort.
• Significant discomfort was more prevalent in female patients, incomplete examinations, and those with diverticulosis.
• Wide variation in sedation (median 95.1%) and analgesia (median 97.3%) use was noted among 290 endoscopists.

Conclusions:

• The study highlights considerable variability in medication practices among colonoscopists in England.
• Medication administration levels did not correlate with patient-reported significant discomfort during screening colonoscopies.
• Patient-related factors and examination outcomes are more influential on comfort than sedation/analgesia dosage.