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Colonoscopy - Part IV

Sedation-free colonoscopy
There is a world over debate that whether the sedative should be given during colonoscopy. World over,in most of countries sedative free colonoscopy is the norm.
Dr. V.K.Mishra mentions the following benefits of sedation-free colonoscopy:
(1) It saves time.The procedure is finished in 10-15 minutes.
(2) It increases safety profile since no anaesthesia is given to patient.
(3) It saves the cost of anesthesia .
(4) It is an easy process.It is more comfortable in men compared to female. This is due to difference in anatomy of intestine of male and female.The previous hysterectomy or pelvic surgery makes it uncomfortable in female.
(5) It is comfortable for obese patients.
(6) Since inner lining of large intestine has no nerve endings,removal of Polyps during sedative free colonoscopy doesn't cause any pain to patient.

Benefits of sedation-free colonoscopy :
Millions of people each year have a colonoscopy and do well, even without sedation. A colonoscopy is the gold standard for colon cancer screening. During the procedure, a doctor can view your entire colon and rectum, and remove potentially premalignant growths called "polyps".By removing these polyps, you reduce the chance of colon cancer.

Colonoscopy without sedation: Sedative free Colonoscopies take roughly 15 to 20 minutes, occasionally longer depending on certain factors. Adding sedation adds takes another 10 to 15 minutes.

Unsedated colonoscopy is usually painless :
Previous studies have reported that 74% of patients felt no pain or only mild discomfort during unsedated colonoscopy.

The causes of severe pain during colonoscopy:
One of the causes of pain during insertion of the colonoscope is stretching of the mesenterium by loop formation of the instrument and the degree of the pain is different from types of looping formation.

Virtual colonoscopy is a special X-ray examination of the colon using low dose computed tomography (CT). It is a less invasive procedure than a conventional colonoscopy. A radiologist reviews the images from the virtual colonoscopy to look for polyps on the inside of the colon that can sometimes turn into colon cancer.

Five reasons why people don't get colonoscopy done:
(1) If there is no family history of colorectal cancer, people think that there is no need for Colonoscopy.In USA colorectal cancer is the third most cause of death due to cancer. In US 85% cases of colorectal cancer have no family history.
(2) People think that incidence of colorectal cancer is low therefore there is no need for screening Colonoscopy. An undetected small polyps may be turned into cancer in 5 to 10 years.By detecting and removing these Polyps in early stage reduces the chance of colorectal cancer in future and make you safe.
(3) People think that preparation prior to colonoscopy is cumbersome and uncomfortable. Nowadays preparation is easy.The powder containing osmotic laxatives and electrolytes ingredients is dissolved in two liter of water and patient is required to drink this in two hours for emptying and cleaning of bowl.
(4) People think that there is long waiting for Colonoscopy. This is not the case.You get appointment in one or two days. However it is delayed only in case of patients with low hemoglobin and co-morbidities such as heart, kidney and liver problems or COPD
(5) People belives that it's expense is not reimbursible by insurance companies .But the fact is most of insurance companies reimburse the expense of Colonoscopy.
Article by Mayo Clinic Health System :
Few people look forward to having a screening colonoscopy. Some people even put off having the procedure done because they hear horror stories that are unfounded. Millions of people each year have a colonoscopy and do well, even without sedation.

A colonoscopy is the gold standard for colorectal cancer screening. During the procedure, a doctor can view your entire colon and rectum, and remove potentially premalignant growths called "polyps". Major medical societies recommend screening for colorectal cancer beginning between the ages of 45 to 50.

For most patients, a sedative is given in intravenous form to help relax and minimize any discomfort during the procedure. But did you know that using a sedative is optional?
In many countries of world, sedation-free colonoscopies are the norm. Patients are alert and engaged during the procedure.

In Mayo Clinic Health System article by Dr Jaime Zighelboim, M.D. Specialties
Gastroenterology & Hepatology (Digestive Care)
answer following five most common questions when discussing a sedation-free option with patients:
Question 1 : What are the benefits of a sedation-free colonoscopy?

(1)Saving time is the first greatest benefit of a sedation-free colonoscopy. If you are sedated for your colonoscopy, you will have restrictions after the procedure until the next day, such as not being able to drive or return to work. You will require a ride home after your procedure, which also may cause your driver to take time off from work. After a sedation-free colonoscopy, you can resume normal activities right away -you can drive, run errands and generally get on with your day.
(2) The second benefit is increased safety. Overall, the sedatives used for colonoscopies are very safe, but there is a small risk of side effects, such as drops in blood pressure, breathing problems, vomiting and prolonged sedation. These are avoided by having a sedation-free colonoscopy.
(3) The third benefit is lower cost. Sedation adds to the procedure's expense. This may be helpful for patients paying out of pocket due to a high-deductible health plan or lack of health insurance.

Question 2:Is a sedation-free colonoscopy painful or uncomfortable?
Answer:Most patients report little or no discomfort during the procedure. You can request sedation during the procedure if you change your mind and feel you need it, although it has been my experience that this seldom occurs.
Selecting a physician who is experienced and comfortable with sedation-free colonoscopies also is important for minimizing any discomfort. When performing a colonoscopy without sedation.Dr.Jaime Zighelboim often employ a technique where he infuses water into the colon as the colonoscope is advanced to make the procedure more tolerable for patients.

Question 3: Who can pick a sedation-free colonoscopy?
Answer:Men may do better than women with sedation-free colonoscopies, due to anatomical differences, but, in general, both usually do well without sedation. A previous hysterectomy and a history of other pelvic or abdominal surgeries may result in scar tissue that can make a sedation-free colonoscopy more difficult for some women. Sedation-free colonoscopies also are easier, in general, in people who are a little overweight compared to those who are very thin. Finally, a sedation-free colonoscopy may not be appropriate if you have a history of anxiety, have had a bad experience with a previous colonoscopy or have a low tolerance for discomfort.

Question 4: Can polyps be removed during a sedation-free colonoscopy?
Answer:Yes. In the vast majority of cases, a physician can remove polyps during a sedation-free colonoscopy. The removal of a polyp is not perceived by the patient because the colon lining does not have nerve endings such as those found on the skin.

Question 5 :What do other patients say about the procedure?
Answer:Almost universally, patients have been very satisfied with the experience and choose it again next time they are due for a colonoscopy. They tell doctor they will recommend it to others as well.
Some people decline having a colonoscopy because they are afraid of the procedure. Yet, there we are many patients who have it completed with no sedatives and are satisfied with the experience. There is no reason to be afraid of a colonoscopy.
(Reference:Article dated 18 March 2021 Mayo Clinic Health System)

Information compiled by: Dr Bhairavsinh Raol