Year 2018 / Volume 110 / Number 4
Original
Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation

223-230

DOI: 10.17235/reed.2018.5287/2017

Israel Grilo-Bensusan, Pablo Herrera Martín, Remedios Jiménez-Mesa, Valle Aguado Álvarez,

Abstract
Background: conscious sedation with benzodiazepines and opiates for colonoscopy is a widespread clinical practice. Objective: to determine the patient’s tolerance to colonoscopy and identify the factors associated with lower tolerance. Methods: a prospective, single-center, descriptive study of patients undergoing ambulatory colonoscopy under conscious sedation. The pain was assessed using a visual analogue scale with a score of 0 to 100 and also qualitatively. Results: three hundred patients with a median age of 54 years completed the study (p25-75: 45-64); 138 were men (46%). Tolerance was good in 273 cases (91%). The median value of tolerance was 13 (p25-p75: 4-33). Pain was considered as mild in 215 (71.7%), moderate in 57 (19%) and intense in 28 (9.3%). In the univariate study, greater pain was associated with females, anxiety, the indication for the procedure, the length of time and difficulty of the examination, and the doses of sedatives. In the multivariate study, both the indication (OR 2.92, 95% CI = 1.03-8.2, p < 0.05) and the difficulty of the examination (OR 4.68, 95% CI = 1.6-13.6, p < 0.01) were significant. Complications were found in 16 patients (5.3%), although all of them were insignificant. Conclusions: tolerance of patients undergoing ambulatory colonoscopy under conscious sedation is good in most cases and complications are infrequent and minor. A worse tolerance to the test is associated with women patients, individuals with anxiety prior to colonoscopy, indication, difficult and longer exploration and lower doses of sedatives.
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24/07/2019 11:50:59
VAYA ROLLO


References
2. Ko HH, Zhang H, Telford JJ,et al. Factors influencing patient satisfaction when undergoing endoscopic procedures. Gastrointest Endosc 2009 ;69(4):883–91,
3. Baudet J-S, Aguirre-Jaime A. The sedation increases the acceptance of repeat colonoscopies. Eur J Gastroenterol Hepatol. 2012;24(7):775–80.
4. Kim HG. Painless colonoscopy: Available techniques and instruments. Clinical Endoscopy. 2016 : 444–8.
6. Triantafillidis JK, Merikas E, Nikolakis D, el al. Sedation in gastrointestinal endoscopy: Current issues. World J Gastroenterol. 2013; p. 463–81.
7. Baudet J-S, Borque P, Borja E, et al. Use of sedation in gastrointestinal endoscopy: a nationwide survey in Spain. Eur J Gastroenterol Hepatol 2009; 21(8):882–8.
8. Lucendo AJ, González-Huix F, et al. Gastrointestinal endoscopy sedation and monitoring practices in Spain: a nationwide survey in the year 2014. Endoscopy 2015;47(4):383–90.
9. Igea F, Casellas JA, Baudet JS, et al. Sedation for gastrointestinal endoscopy Clinical practice guidelines of the spanish society of digestive endoscopy. Endoscopy. 2014;(46):720–31.
10. Obara K, Haruma K, Irisawa A, et al. Guidelines for sedation in gastroenterological endoscopy . Digestive Endoscopy. 2015 p. 435–49.
11. Hazeldine S, Fritschi L, Forbes G. Predicting patient tolerance of endoscopy with conscious sedation. Scand J Gastroenterol. 2010 ;45(10):1248–54
12. Czwornog J, Austin GL. Body mass index, age, and gender affect prep quality, sedation use, and procedure time during screening colonoscopy. Dig Dis Sci. 2013;58(11):3127–33.
13. Eckardt AJ, Swales C, Bhattacharya K, et al. Open access colonoscopy in the training setting: which factors affect patient satisfaction and pain? Endoscopy. 2008;40(2):98–105.
14. Elphick DA, Donnelly MT, Smith KS, et al. Factors associated with abdominal discomfort during colonoscopy: a prospective analysis. Eur J Gastroenterol Hepatol. 2009;21(9):1076–82.
15. Bal BS, Crowell MD, Kohli DR, et al. What factors are associated with the difficult-to-sedate endoscopy patient? Dig Dis Sci. 2012;57(10):2527–34.
16. Peña LR, Mardini HE, Nickl NJ. Development of an instrument to assess and predict satisfaction and poor tolerance among patients undergoing endoscopic procedures. Dig Dis Sci . 2005;50(10):1860–71.
17. Chung KC, Juang SE, Lee KC, et al. The effect of pre-procedure anxiety on sedative requirements for sedation during colonoscopy. Anaesthesia. 2013;68(3):253–9.
18. Shingina A, Ou G, Takach O, et al. Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy: Canadian tertiary center experience. World J Gastrointest Endosc. 2016;8(20):770–6.
20. Braunstein ED, Rosenberg R, Gress F, et al. Development and validation of a clinical prediction score (the SCOPE score) to predict sedation outcomes in patients undergoing endoscopic procedures. Aliment Pharmacol Ther. 2014;40(1):72–82.
21. McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc. 2008 May;67(6):910–23.
22. Finn RT, Boyd A, Lin L, et al. Bolus Administration of Fentanyl and Midazolam for Colonoscopy Increases Endoscopy Unit Efficiency and Safety Compared With Titrated Sedation. Clin Gastroenterol Hepatol. 2017 Sep;15(9):1419–1426.e2.
23. Schroeder C, Kaoutzanis C, Tocco-Bradley R, et al. Patients Prefer Propofol to Midazolam Plus Fentanyl for Sedation for Colonoscopy: Results of a Single-Center Randomized Equivalence Trial. Dis Colon Rectum 2016;59(1):62–9.
24. Padmanabhan A, Frangopoulos C, Shaffer LET. Patient Satisfaction With Propofol for Outpatient Colonoscopy: A Prospective, Randomized, Double-Blind Study. Dis Colon Rectum. 2017;60(10):1102–8.
25. Hayee B, Dunn J, Loganayagam A, et al. Midazolam with meperidine or fentanyl for colonoscopy: results of a randomized trial. Gastrointest Endosc. 2009;69(3 Pt 2):681–7.
26. Aljebreen AM, Almadi M a., Leung FW. Sedated vs unsedated colonoscopy: A prospective study. World J Gastroenterol. 2014;20(17):5113–8.
27. Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. 2017;49.
28. Paggi S, Radaelli F, Amato A, et al. Unsedated colonoscopy: An option for some but not for all. Gastrointest Endosc; 2012;75(2):392–8.
29. Saunders BP, Fukumoto M, Halligan S, et al. Why is colonoscopy more difficult in women? Gastrointest Endosc. 1996;43(2 Pt 1):124–6.
30. Takahashi Y, Tanaka H, Kinjo M, et al. Prospective evaluation of factors predicting difficulty and pain during sedation-free colonoscopy. Dis Colon Rectum. 2005;48(6):1295–300.
31. Lin OS, Schembre DB, Ayub K, et al. Patient satisfaction scores for endoscopic procedures: impact of a survey-collection method. Gastrointest Endosc. 2007;65(6):775–81.
1. Rex DK, Johnson DA, Anderson JC et al. American College of Gastroenterology guidelines for colorectal cancer screening. Am J Gastroenterol 2009; 104(3):739–50.
19 Grilo Bensusan I, Herrera Martín P, Aguado Álvarez V. Prospective study of anxiety in patients undergoing an outpatient colonoscopy Rev Esp Enferm Dig. 2016;108(12):765-769
5. Dumonceau J-M, Riphaus A, Beilenhoff U, et al. European Curriculum for Sedation Training in Gastrointestinal Endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA). Endoscopy 2013;235(45):496–504.
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Grilo-Bensusan I, Herrera Martín P, Jiménez-Mesa R, Aguado Álvarez V. Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation. 5287/2017


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Publication history

Received: 30/09/2017

Accepted: 26/02/2018

Online First: 26/03/2018

Published: 02/04/2018

Article revision time: 140 days

Article Online First time: 177 days

Article editing time: 184 days


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