Role of Colonoscopy Without Sedation: A Retrospective Study on the Safety, Benefits and Tolerability: 506

Introduction: Background: Colonoscopy is considered to be the gold standard test in evaluating for colorectal disease. Abdominal discomfort and pain is one of the major concerns for patients undergoing colonoscopy. To overcome these concerns often conscious sedation (CS) or Monitored Anesthesia Care (MAC) is utilized to sedate the patient. In the United States (US) patients universally receive sedation. However unsedated colonoscopy is acceptable in many developed and under developed countries. In the US unsedated colonoscopy is often patient driven and offered to approximately 1-2% of cases. Aim: To determine the safety, benefits and tolerability of unsedated colonoscopy. Methods: A retrospective study from a community-based private practice gastroenterology group that performs colonoscopies at Sierra Endoscopy Center, a free-standing, ambulatory surgery center in Grass Valley, California. Electronic medical records from January 2002 through September 2016 were reviewed. All patients who underwent colonoscopy without sedation were included in the study. Data was collected on patient demographics, pertinent surgical history, employment level, BMI, prior history of sedated or unsedated colonoscopy and indications and findings of the procedure. Type of colonoscope used was recorded. Procedure outcomes measured included success in reaching the cecum, time to cecum, need for rescue sedation, and complications. Patient outcomes included reason to request no sedation, anxiety level, pain or discomfort during the procedure and overall procedure satisfaction. Results: See table 1 and 2. Conclusion: In the US, Colonoscopy without sedation is patient driven and overall safe, successful and satisfactory to the patients. Size of scope is not a predictor to success or patient satisfaction. An open dialogue with patients reluctant in having a colonoscopy because of concern about sedation may result in patients agreeing to an unsedated procedure, potentially increasing colorectal cancer screening rates in this subgroup of patients. An unsedated colonoscopy reduces recovery time and may promote efficiency in an endoscopy center.Table: Table. Demographics, Indications and FindingsTable. Outcomes