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Usedated colonoscopy is routinely available in many parts of the world. In the US, only educated professionals appear to be knowledgeable enough to request the unsedated option. Colonoscopists have also been willing to perform unsedated colonoscopy when a patient presents without an escort after undergoing bowel purge preparation. While the actual side-effects of sedation are minimal, the escort requirement and time burden of sedation are barriers to the uptake of screening colonoscopy in the US.
The recent trend of deep sedation with propofol for screening colonoscopy increases the efficiency of the colonoscopists at significant costs e. The options of as needed and on demand sedation permit patients to complete colonoscopy without sedation. The latter appears to be potentially less coercive.
Nurses with experience in the unsedated options recognize the benefit of the quick turn-around of the examination room and shortened occupancy of the recovery area. Discharge planning can be optimized due to absence of amnesia. Patients completing unsedated colonoscopy have given their endorsement of the options. A recently described water method warm water infusion in lieu of air insufflation combined with removal of all residual colonic air by suction and residual feces by water exchange has the potential of decreasing procedural discomfort and enhancing cecal intubation in unsedated colonoscopy.
The availability of the novel water method assures colonoscopists that high success rate of cecal intubation can be achieved in the unsedated patients. Unsedated colonoscopy is available on a routine basis in many parts of the world. In the end we shall address the question in the title of this manuscript if there is a place for sedationless unsedated colonoscopy. An interesting historical note is that colonoscopy was initially developed as an unsedated procedure and procedural difficulty led to the introduction of sedation.
A recent report in the primary care literature, however, suggested that sedation may be a barrier to colonoscopy screening. The need to take time off work after sedation was also an important negative incentive.