Original Article

Who Is Willing to Undergo Endoscopy Without Sedation: Patients, Nurses, or the Physicians?

Authors: Anand Madan, MD, Anil Minocha, MD, FACG

Abstract

Objectives: Some studies suggest that the majority of the United States population is now willing to undergo unsedated endoscopy. We studied the willingness of patients, nurses, and physicians to undergo endoscopy without sedation.


Methods: Adult patients presenting to us for outpatient endoscopy at two large tertiary care level 1 trauma hospitals were asked to fill out a survey questionnaire recording their demographic information, prior experience with endoscopy and sedation, and whether they were willing to undergo unsedated endoscopy. Their anxiety level was assessed using the Beck Anxiety Inventory. After the endoscopic procedure, patients were asked whether they had any change in their decision regarding unsedated endoscopy. A random convenience sample of physicians and nurses were also given a questionnaire asking about their experience with endoscopy and whether they were willing to undergo such procedures without sedation.


Results: A total of 127 patients, 117 nurses, and 51 physicians participated in the study. Only 19.5% of patients were willing to undergo upper endoscopy without sedation. Among patients, the willingness dropped to 6.75% postprocedurally. Results were similar for colonoscopy. Physicians were least likely to agree to an unsedated procedure (2.2%). Gastroenterology (GI) nurses were more likely to undergo unsedated esophagogastroduodenoscopy (39.3%) as opposed to non-GI nurses (7.1%, P < 0.001). 19.6% of GI nurses agreed to unsedated colonoscopy versus 0% in the non-GI group (P = 0.001). Preprocedure anxiety level was not found to be a predictor for willingness to undergo unsedated endoscopy. Female patients were more likely to forego sedation preprocedurally (OR = 5.75; 95% CI = 2.05–16.2). However, postprocedurally, gender was no longer a significant predictor. Similarly, among the nurses and physicians, neither age nor gender was a significant predictor of willingness to undergo unsedated endoscopy. Patients with a high school (OR = 0.01; 95% CI = 0.01–0.06) or associates degree (OR = 0.02; 95% CI = 0.01–0.35) were less likely to forego sedation.


Conclusion: In contrast to reports from some major medical centers, the current study found that most patients as well as medical professionals were unwilling to undergo endoscopy without sedation.


Key Points


* Most patients are unwilling to undergo unsedated endoscopy.


* Health care professionals are less willing than patients to forego sedation for endoscopy.


* Willingness to undergo unsedated endoscopy is unrelated to anxiety levels.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Keefe EB, O'Connor KW. 1989 ASGE survey of endoscopic sedation and monitoring practices.Gastrointest Endosc 1990;36:S13–S18.
 
2. Ristikankare M, Julkunen R. Premedication for gastrointestinal endoscopy is a rare practice in Finland: a nationwide survey. Gastrointest Endosc 1998;47:204–207.
 
3. Froehlich F, Gonvers JJ, Fried M. Conscious sedation, clinically relevant complications and monitoring of endoscopy: results of a nationwide survey in Switzerland. Endoscopy 1994;26:231–234.
 
4. Rex DK, Imperiale TF, Portish V. Patients willing to try colonoscopy without sedation: Associated clinical factors and results of a randomized controlled trial. Gastrointest Endosc 1999;49:554–559.
 
5. Hoffman MS, Butler TW, Shaver T. Colonoscopy without sedation. J Clin Gastroenterol1998;26(4):279–282.
 
6. Ristikankare M, Julkunen R, Mattila M et al. Conscious sedation and cardiorespiratory safety during colonoscopy. Gastrointest Endosc 2000;52:48–54.
 
7. Early DS, Saifuddin T, Johnson JC et al. Patient attitudes toward undergoing colonoscopy without sedation. Am J Gastroenterol 1999;94:1862–1865.
 
8. Thiis-Evensen E, Hoff GS, Sauar J et al. Patient tolerance of colonoscopy without sedation during screening examination for colorectal polyps. Gastrointest Endosc 2000;52:606–610.
 
9. Cataldo PA. Colonoscopy without sedation. Dis Colon Rectum 1996;39:257–261.
 
10. Ladas SD. Factors predicting the possibility of conducting colonoscopy without sedation. Endoscopy 2000;32(9):688–692.
 
11. Jones MP, Ebert CC, Sloan T, et al. Patient anxiety and elective gastrointestinal endoscopy. J Clin Gastroenterol 2004;38:35–40.
 
12. Smolen D, Topp R, Singer L. The effect of self-selected music during colonoscopy on anxiety, heart rate, and blood pressure. Appl Nurs Res 2002;15:126–136.
 
13. Mulcahy HE, Kelly P, Banks MR, et al. Factors associated with tolerance to, and discomfort with, unsedated diagnostic gastroscopy. Scand J Gastroenterol 2001;36:1352–1357.
 
14. Campo R, Brullet E, Montserrat A, et al. Identification of factors that influence tolerance of upper gastrointestinal endoscopy. Eur J Gastroenterol Hepatol 1999;11:201–204.
 
15. Schutz SM, Lee JG, Schmitt CM, et al. Clues to patient dissatisfaction with conscious sedation for colonoscopy. Am J Gastroenterol. 1994;89:1476–1479.