Sedation-Free Colonoscopy Using an Upper Endoscope Is Tolerable and Effective in Patients with Low Body Mass Index: A Prospective Randomized Study

• Published in: The American journal of gastroenterology Vol. 101; no. 11; pp. 2504 - 2510
• Main Authors: PARK, Chang-Hwan, LEE, Wan-Sik, JOO, Young-Eun, KIM, Hyun-Soo, CHOI, Sung-Kyu, REW, Jong-Sun, KIM, Sei-Jong
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.11.2006; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Body Mass Index; Cecum; Colonoscopes; Colonoscopy - methods; Digestive system. Abdomen; Endoscopes; Endoscopy; Female; Gastroenterology; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Intestinal Polyps - pathology; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pain; Patient Acceptance of Health Care; Prospective Studies; Human; Body mass index; Endoscopy; Sedation; Colonoscopy; Endoscope
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2006.00790.x

Small-caliber upper endoscopes can be used safely and effectively for sedation-free colonoscopy. The objective of the study is to assess the efficacy of a small-caliber upper endoscope (9.2 mm) comparing with a standard colonoscope (12.2 mm). In a prospective trial, patients undergoing sedation-free colonoscopy were randomly assigned to the upper endoscope (E) or the standard colonoscope (C). Outcome measures included patient self-assessed pain score (4-point scale), endoscopist-assessed pain score (4-point scale), cecal intubation rate, difficult cecal intubation rate (>900 s), number of polyps detected, and complication rates. A total of 244 patients were entered. Clinical characteristics were not different between the two groups. Cecal intubation was achieved in 91.0% of the patients in each group. The mean patient self-assessed pain score (SD) was significantly lower in the E group compared with the C group: 1.44 (0.81) versus 2.08 (1.10), p < 0.001. The mean endoscopist assessment of patient pain score (SD) was significantly lower in the E group compared with the C group as well: 1.27 (0.67) versus 1.58 (0.90), p= 0.003. In patients with low body mass index (BMI < 22 kg/m(2)), the cecal intubation rate was significantly higher in the E group (97.7%vs 79.4%, p= 0.026) and the difficult cecal intubation rate was significantly lower in the E group (9.3%vs 32.4%, p= 0.011). There were no significant differences in the number of polyps detected and complication rates between the two groups. A small-caliber upper endoscope is tolerable and effective for sedation-free colonoscopy, especially in patients with low BMI.