A recent article published by Gastroenterology & Endoscopy News detailed an increasing number of physicians implementing sedationless colonoscopies. New technologies have enabled patients to have more options for how they want their colonoscopy to proceed and have given doctors more room to come up with procedural methods that make colonoscopies available without going to sleep while still remaining relatively pain free.
The option of sedationless colonoscopy has been around for about 10 years or so, after a study performed by Douglas Rex, MD and others who found that specifically older men in good health could be good candidates for colonoscopy without sedation. The techniques and procedures for sedationless colonoscopy are still under development and require the use of variable- stiffness and pediatric colonoscopes in order to have a comfortable procedure.
There are still many elements that need to be worked out and Dr. Howell, a physician who had been performing sedationless colonoscopy for about 12 years now, has developed a method for determining which patients would fare well and which would struggle with the sedationless procedure. The screening process developed by Dr. Howell eliminated those who had previously required significant medication during a colonoscopy, those with a body mass index (BMI) below 20, women who had pelvic surgery, have a history of endometriosis, those who have undergone radiation, or those who suffer from chronic pelvic pain.
He found that when using this pre-screening method only 10 percent of patients who underwent colonoscopy while they were awake made additional requests for pain medication. Further their study looked at over 600 patients and found that, not only were the majority of patients able to complete the exam effectively, but also eliminated those patients who would not benefit from sedationless colonoscopy. Once again Dr. Howell found that the best candidates were middle aged to older men, who often do not face many of the problems used as eliminating criteria. Using his screening process he performs sedationless colonoscopy on about 30% of women and 50% of men.
Sedationless colonoscopy offers several benefits; most importantly in the eyes of Dr. Howell is how cost efficient it is. Without the need to go to sleep you no longer have to pay for an anesthesiologist to monitor and perform the sedation. Additionally, it allows patients to get in and out of the office without needing someone else to drive them and with relatively fewer side effects. Finally, sedationless colonoscopy is commonly used in many countries without major complaints of patient discomfort. It is important that both you and your physician speak about your specific situation before deciding that this type of colonoscopy is right for you.