Painless colonoscopy

Authors: S. Cadoni
Authors‘ workplace: Digestive Endoscopy Unit, S. Barbara Hospital, Iglesias (CI), Italy
Published in: Gastroent Hepatol 2014; 68(3): 192-193


Autor deklaruje, že v souvislosti s předmětem studie nemá žádné komerční zájmy.

Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.

Colonoscopy is the gold standard for examination of the large bowel, but it can be a painful procedure when performed without sedation. Distension and elongation of the colon by air insufflation (AI), loop formation – particularly at the sigmoid with consequent stretching of its mesenteric attach­ments [1] – and abdominal compres­sion applied to help the progression of the instrument, are all contributing factors generating pain, particularly during the insertion phase.

Sedatives and/or analgesics are commonly given to improve patient satisfaction with the examination. This has led to their widespread and increasing use, with the associated need for recovery and escort requirement, post-procedure activity restrictions, increased costs and medication-related complications [2–5]. Painful colonoscopy and the need for sedation/analgesia have been found to be associated especially with females, younger age, previous pelvic surgery, body mass index < 18.5 kg/m2 and pre-procedural anxiety [2,6–8].

Unsedated colonoscopy, or colonoscopy with on-demand sedation ­[8–10], are feasible and represent a viable option for many patients, even in colorectal cancer screening settings [11–13] particularly for those unable to undergo sedation due to lack of an escort [11–14].

Obviously the use of methods that inflict less pain during colonoscopy would render unsedated/on-demand sedation procedures more acceptable and reduce the use of medications.

Several methods for decreasing patient pain during the insertion phase of colonoscopy have been investigated to achieve an easier, safer and more acceptable exploration of the colon. These include the use of small-calibre colonoscopes and endoscopes designed for the upper gastrointestinal tract [15,16], variable-stiffness colonoscopes [17], insufflation with carbon dioxide (CO2) instead of air [18], magnetic endoscope imaging (MEI) [19], and use of water-aided colonoscopy (WAC), in which warm water is used in lieu of air insufflation during insertion [20].

Some of the above-mentioned instrumentations are expensive or not easily available, while WAC is a unique example of an inexpensive way to decrease pain during the insertion phase of colonoscopy. Formally recognized by the Technology Assessment Committee of the ASGE [21], WAC can reduce pain during the procedure and the need for sedation [22–26]. It can be broadly subdivided into water immersion (WI), which is characterized by suction removal of the infused water predominantly during the with­drawal phase; and water exchange (WE), characterized by suction removal of the infused water predominantly dur­ing the insertion phase [20]. WI and WE make colonoscopy easier and less painful [22–28], reduce the need for sedation [22,24–26,28], and increase patient willingness to repeat the examination [22,25,28].

Uniquely, WE is the least painful ­method and may enhance the adenoma detection rate (ADR), particularly in the proximal colon and for adenomas < 10 mm, with obvious advantages in screening settings [22,23,26–28].

WAC is the focus of an interesting review in this issue of Gastroenterologie a hepatologie [29], and the ESGE Live Demonstration event in Prague ­(12–13th September 2014) will have a session devoted entirely to painless colonoscopy. Don’t miss it!

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Sergio Cadoni, M.D.

Digestive Endoscopy Unit

S. Barbara Hospital

Iglesias (CI), Italy 09016


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Paediatric gastroenterology Gastroenterology and hepatology Surgery

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