Health care providers' acceptance of unsedated colonoscopy before and after a state-of-the-art lecture on the feasibility of the option

The impact of education on acceptance of unsedated colonoscopy by health care providers is unknown. To test the hypothesis that knowledge imparted by a lecture on unsedated colonoscopy is associated with its enhanced acceptance. Settings and Design: At the State-of-the-Art Lecture on "Unsedated colonoscopy: Is it feasible?" presented at the 8th Pan-Arab Conference on Gastroenterology, February, 2011, Riyadh, Saudi Arabia, a questionnaire survey of the audience was undertaken. Materials and Methods: An expectation questionnaire was administered before and after the lecture. Attendees responded anonymously. Statistical analysis used: The responses of a convenient sample of 49 attendees who provided completed responses to the questionnaire both before and after the lecture were analyzed. Data are expressed as frequency counts and means +/- SEM. Repeated measures analysis of variance [ANOVA], ANOVA with contrasts and Chi-square analysis [Stat view II Program for Macintosh computers] were used to assess the data. A P value of<0.05 is considered significant. The mean +/- SEM credibility score [maximum possible score=50] was 25.8 +/- 1.8 before and 33.3 +/- 2.1 after the lecture, with a significant improvement in mean score of 7.5 +/- 1.3 [P=0.001, paired t test]. Nineteen [39%] respondents were not willing to consider unsedated colonoscopy for themselves before the lecture. This number decreased to 13 [27%] after the lecture. Before the lecture only 4 [8%] respondents were willing to consider unsedated colonoscopy for themselves. After the lecture this number increased to 8 [16%]. The data suggest education of healthcare professionals regarding the feasibility of unsedated colonoscopy appears to enhance its acceptance as a credible patient care option at a Pan-Arab Gastroenterology Conference

Unsedated colonoscopy: is it feasible?

Unsedated colonoscopy has been an evolving subject ever since its initial description four decades ago. Failure in unsedated diagnostic cases due to patient pain led to the introduction of sedation. Extension to screening cases, albeit logical, created a sedation-related barrier to colonoscopy screening. In recent years a water method has been developed to combat the pain during unsedated colonoscopy in the US. In randomized controlled trials the water method decreases pain, increases cecal intubation success, and enhances the proportion of patients who complete unsedated colonoscopy. The salvage cleansing of suboptimal bowel preparation by the water method serendipitously may have increased the detection of adenoma in both unsedated and sedated patients. The state-of-the-art lecture concludes that unsedated colonoscopy is feasible. The hypothesis is that recent advances, such as the development of the water method, may contribute to reviving unsedated colonoscopy as a potentially attractive option for colon cancer screening and deserves to be tested

Unsedated Colonoscopy and the Water Method for Minimizing Discomfort in the Unsedated Patients

A decade ago, failure of cecal intubation due to pain in ~20% of scheduled unsedated patients in the author's veterans practice prompted the search for a less uncomfortable approach. Methods that minimized discomfort or enhance cecal intubation included use of pediatric, variable stiffness, computer-assisted, 3-dimensional magnetic imaging colonoscope, gastroscope, and inhalation of nitrous oxide or insufflation of carbon dioxide; use of hypnosis, music, audio distraction, or simply allowing patients to participate in medication administration. In addition, several water-related techniques (as adjuncts to air insufflation) enhanced speed and success of intubation, reduced discomfort but did not appear to alter the amount of medications used. Because of simplicity, the water-related techniques added to turning off of the air pump were evaluated in a series of trial-and-error modifications. The result was the development of a water infusion in lieu of air insufflation method. Subsequent refinements included suction removal of all residual air to minimize angulations at flexures. Water exchange during insertion was used to suspend and removal feces to clear the luminal view while distention of the colonic lumen was minimize. Observational studies followed by randomized controlled trials confirmed the water method (simplified nomenclature) had significant impacts on discomfort both during and after colonoscopy: reduction of medication requirement; attenuation of insertion-related discomfort, enhancement of cecal intubation, decrease of pain after colonoscopy, increase in reported willingness to repeat unsedated colonoscopy in the patients examined without sedation and reduction of recovery time burden in patients accepting the option of sedation on demand.