New York-Presbyterian/Columbia University Medical Center New York, NY
Fatima Khan, MD, Chin Hur, MD, MPH, Benjamin Lebwohl, MD, MS, Anna Krigel, MD; New York-Presbyterian/Columbia University Medical Center, New York, NY
Introduction: In the United States, colonoscopy is most often performed with sedation, but colonoscopy can be successfully performed without sedation. Despite the potential for cost-saving and improved safety, outcomes data on unsedated colonoscopy are scarce. We aimed to determine patient characteristics associated with undergoing unsedated colonoscopy and to determine whether adenoma detection rate (ADR) and cecal intubation rate (CIR) differ between sedated and unsedated colonoscopy. Methods: Using a single-center electronic endoscopy database, we identified patients who underwent outpatient colonoscopy from 2011 through 2018 with sedation (conscious sedation or anesthesia assistance) or without. Patients were excluded from analysis if they had surgically altered anatomy or underwent colonoscopy that was not intended to reach the cecum.We used multivariable logistic regression to determine factors associated with unsedated colonoscopy, cecal intubation, and the detection of at least one adenoma. Results: We identified 24,795 patients who underwent colonoscopy during the study period. Of these, 179 patients (0.7%) underwent unsedated colonoscopy. ADR was 27.4% in sedated and 21.2% in unsedated colonoscopies (p= 0.06); CIR was 95.8% in sedated and 85.5% in unsedated patients (p< 0.01). On multivariable analysis, male sex (OR 2.06, CI 1.52-2.79) and suboptimal bowel preparation (OR 1.75, CI 1.24-2.45) were associated with undergoing unsedated colonoscopy, while higher BMI was inversely associated with unsedated colonoscopy (BMI 25-29.9 compared to BMI 18-24.9: OR 0.44, CI 0.25- 0.77). On multivariable analysis, colonoscopy with sedation was associated with cecal intubation (OR 3.79, CI 2.39-6.00) and the detection of at least one adenoma (OR 1.45, OR 1.003-2.10). Discussion: We found that undergoing outpatient colonoscopy with sedation as opposed to no sedation was significantly associated with a higher CIR and ADR. Our findings suggest sedation is necessary to meet current CIR and ADR guidelines. However, given the potential cost and safety benefits of unsedated colonoscopy, further investigation into methods to improve patient selection and colonoscopy quality indicators in unsedated colonoscopy is warranted.
Table 1: Univariate analysis of colonoscopies with and without sedation (n= 24,795).
Table 2: Multivariable analysis of factors associated with unsedated colonoscopy (n= 179).
Disclosures: Fatima Khan indicated no relevant financial relationships. Chin Hur indicated no relevant financial relationships. Benjamin Lebwohl indicated no relevant financial relationships. Anna Krigel indicated no relevant financial relationships.