title: Unsedated colonoscopy: an option for some but not for all.
abstract: BACKGROUND
  The increasing request for colonoscopy in clinical practice, coupled with the lack of time, has led to a renewed interest in unsedated procedures.
  
  
  OBJECTIVE
  To evaluate the acceptability of unsedated colonoscopy and to characterize the subset of patients more likely to undergo and complete the procedure without sedation and/or analgesia.
  
  
  METHODS
  Prospective, population study.
  
  
  METHODS
  Nonacademic community hospital, 6-month observation period.
  
  
  METHODS
  Adult outpatients referred for colonoscopy were offered unsedated procedure, with the possibility of on-demand sedation.
  
  
  METHODS
  Demographics, clinical features, and endoscopy outcomes were recorded. Data were analyzed by stepwise logistic regression analysis, and odds ratio (OR) and 95% confidence interval (CI) are given for significant variables.
  
  
  METHODS
  Unsedated colonoscopy acceptance rate. Factors significantly associated with acceptance and completion of unsedated procedures.
  
  
  RESULTS
  The acceptance rate for unsedated colonoscopy was 56.2% of 964 consecutive evaluated patients. The cecal intubation rate in unsedated patients was 81.6% and increased to 97.3% with the option of on-demand sedation. At multivariate analysis, factors significantly associated with the acceptance were no previous colonoscopy (OR 1.52; 95% CI, 1.10-2.11), absent/low level of anxiety (OR 3.82; 95% CI, 2.71-5.38), and no concern about the examination (OR 1.80; 95% CI, 1.17-2.77). Fear of procedure-related pain was inversely associated with acceptance (OR 0.28; 95% CI, 0.17-0.35). Factors associated to drug-free colonoscopy completion were absence of preprocedure anxiety (OR 1.87; 95% CI, 1.08-3.21) and male sex (OR 3.59; 95% CI, 2.13-6.05).
  
  
  CONCLUSIONS
  Single-center study.
  
  
  CONCLUSIONS
  The acceptance rate of unsedated colonoscopy is clinically relevant, and the procedure can be completed without sedation in the majority of patients. Subject-related factors may help to identify patients willing to undergo and potentially complete unsedated procedures.
authors.affiliation: Gastroenterology Unit, Valduce Hospital, Como, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Paggi
authors.forename: Franco
authors.initials: F
authors.lastname: Radaelli
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Amato
authors.forename: Gianmichele
authors.initials: G
authors.lastname: Meucci
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Spinzi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rondonotti
authors.forename: Vittorio
authors.initials: V
authors.lastname: Terruzzi
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology; D003113:Colonoscopy / Q000379:methods* / Q000523:psychology; D016001:Confidence Intervals; D054810:Deep Sedation; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012737:Sex Factors