Background: Fear of pain and sedation-related adverse events are impediments for patients to attend endoscopic screening or surveillance programs. Objective: To investigate the long-term effect of different sedation protocols in patients undergoing screening or surveillance endoscopy. Moreover, motivation of patients to decline endoscopic procedures was evaluated by focusing on the patient's satisfaction, fear and pain in relation to type of sedation used. Methods: Design: A prospective, double-blind controlled trial data collection was performed by using a standardized clinical questionnaire followed by a telephone interview 3-4 weeks after the initial endoscopic procedure. Setting: The study was conducted at the Department of Medicine I at the University Hospital of Erlangen-Nuremberg. Data collection was performed during June 2012 till April 2013. Patients: Overall, 307 patients were prospectively evaluated (44.3% female, mean age 51 ± 17.4 years; mean BMI 25.5 ± 5.7). 247 patients (80.5%) were outpatients, 60 inpatients (19.5%). Interventions: Endoscopic procedures were divided into five groups: (i) procedures in the upper gastrointestinal tract, (ii) complete colonoscopies, (iii) ileocolonoscopies, (iv) incomplete colonoscopies, and (v) other procedures. Main outcome measurements: Patient satisfaction, fear and pain were measured in a structured and standardized clinical interview using a 6-point numerical rating scale, where 1 was ‘very satisfied/no pain' and 6 was ‘very unsatisfied/unsupportable pain'. Results: Different types of sedation were assessed: propofol in monosedation (6.5%), combination of propofol + meperidine (41.0%), combination of midazolam + meperidine (48.5%) and other combinations (3.9%). Patient satisfaction was significantly reduced regarding fear and pain during the endoscopic procedure (p = 0.001 and p = 0.0001, respectively). All patients receiving propofol monosedation indicated significantly less pain in comparison to other sedation groups (p < 0.0001). Moreover, sedation with midazolam + meperidine increased the fear during the procedure significantly in comparison to monosedation with propofol (p = 0.082). Propofol/meperidine in combination and midazolam/meperidine increased the probability for cardiovascular events in comparison to monosedation with propofol (p = 0.005; p = 0.039). Finally, we observed significantly lower doses of propofol when used in monosedation than propofol in combination with meperidine (p = 0.066). Limitation: Single-center study at a tertiary referral center. Conclusions: Propofol in monosedation should preferably be used for patient sedation in screening and surveillance endoscopies. Whether this approach could also improve participation rates in screening and surveillance endoscopies requires further investigations.

1.
Boyle P, Langman JS: ABC of colorectal cancer: Epidemiology. BMJ 2000;321:805-808.
[PubMed]
2.
Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM, et al: American College of Gastroenterology guidelines for colorectal cancer screening 2009 (corrected). Am J Gastroenterol 2009;104:739-750.
[PubMed]
3.
Brenner H, Hoffmeister M, Brenner G, Altenhofen L, Haug U: Expected reduction of colorectal cancer incidence within 8 years after introduction of the German screening colonoscopy programme: estimates based on 1,875,708 screening colonoscopies. Eur J Cancer 2009;45:2027-2033.
[PubMed]
4.
Baudet JS, Diaz-Bethencourt D, Aviles J, Aguirre-Jaime A: Minor adverse events of colonoscopy on ambulatory patients: the impact of moderate sedation. Eur J Gastroenterol Hepatol 2009;21:656-661.
[PubMed]
5.
Abraham NS, Fallone CA, Mayrand S, Huang J, Wieczorek P, Barkun AN: Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy: a Canadian randomized controlled cost-outcome study. Am J Gastroenterol 2004;99:1692-1699.
[PubMed]
6.
Lee MG, Hanna W, Harding H: Sedation for upper gastrointestinal endoscopy: a comparative study of midazolam and diazepam. Gastrointest Endosc 1989;35:82-84.
[PubMed]
7.
Cohen LB, Delegge MH, Aisenberg J, Brill JV, Inadomi JM, Kochman ML, et al: AGA Institute review of endoscopic sedation. Gastroenterology 2007;133:675-701.
[PubMed]
8.
Riphaus A, Wehrmann T, Weber B, Arnold J, Beilenhoff U, Bitter H, et al: S3 guidelines - sedation in gastrointestinal endoscopy (in German). Z Gastroenterol 2008;46:1298-1330.
[PubMed]
9.
De Wijkerslooth TR, de Haan MC, Stoop EM, Bossuyt PM, Thomeer M, van Leerdam ME, et al: Reasons for participation and nonparticipation in colorectal cancer screening: a randomized trial of colonoscopy and CT colonography. Am J Gastroenterol 2012;107:1777-1783.
[PubMed]
10.
Baudet JS, Aguirre-Jaime A: The sedation increases the acceptance of repeat colonoscopies. Eur J Gastroenterol Hepatol 2012;24:775-780.
[PubMed]
11.
Ussui VM, da Silva AL, Borges LV, da Silva JG, Zeitune JM, Hashimoto CL: What are the most important factors regarding acceptance to the colonoscopy? Study of related tolerance parameters. Arq Gastroenterol 2013;50:23-30.
[PubMed]
12.
Froehlich F, Harris JK, Wietlisbach V, Burnand B, Vader JP, Gonvers JJ, et al: Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE). Endoscopy 2006;38:461-469.
[PubMed]
13.
Porostocky P, Chiba N, Colacino P, Sadowski D, Singh H: A survey of sedation practices for colonoscopy in Canada. Can J Gastroenterol 2011;25:255-260.
[PubMed]
14.
Ladas SD, Satake Y, Mostafa I, Morse J: Sedation practices for gastrointestinal endoscopy in Europe, North America, Asia, Africa and Australia. Digestion 2010;82:74-76.
[PubMed]
15.
Riphaus A, Macias-Gomez C, Deviere J, Dumonceau JM: Propofol, the preferred sedation for screening colonoscopy, is underused. Results of an international survey. Dig Liver Dis 2012;44:389-392.
[PubMed]
16.
Versorgung Zfdk. Feedback-Bericht Früherkennungs-Koloskopie. Erstellt im Auftrag der Kassenärztlichen Bundesvereinigung und des GKV-Spitzenverbandes; in Praxis Dr. med. Helmut Neumann LS, 32105 Bad Salzuflen, editor, 2012.
17.
Poulos JE, Kalogerinis PT, Caudle JN: Propofol compared with combination propofol or midazolam/fentanyl for endoscopy in a community setting. AANA J 2013;81:31-36.
[PubMed]
18.
Moerman AT, Struys MM, Vereecke HE, Herregods LL, De Vos MM, Mortier EP: Remifentanil used to supplement propofol does not improve quality of sedation during spontaneous respiration. J Clin Anesth 2004;16:237-243.
[PubMed]
19.
Riphaus A, Geist F, Wehrmann T: Endoscopic sedation and monitoring practice in Germany: re-evaluation from the first nationwide survey 3 years after the implementation of an evidence and consent based national guideline. Z Gastroenterol 2013;51:1082-1088.
[PubMed]
20.
Pascual MG, Zayas Berbes M, Saez Banos M, Abreu Vazquez Mdel R, Martinez Leyva L: Propofol versus midazolam and pethidine in the colonoscopy realization (in Spanish). Acta Gastroenterol Latinoam 2011;41:214-220.
[PubMed]
21.
Grünhage F, Seegmüller A, Lammert F: Effect of different sedation on critical flicker frequency, a diagnostic tool for minimal encephalopathy. Z Gastroenterol 2013;51:K261.
22.
Sipe BW, Rex DK, Latinovich D, Overley C, Kinser K, Bratcher L, et al: Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc 2002;55:815-825.
[PubMed]
23.
VanNatta ME, Rex DK: Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol 2006;101:2209-2217.
[PubMed]
24.
DiPalma JA, Herrera JL, Weis FR, Dark-Mezick DL, Brown RS: Alfentanil for conscious sedation during colonoscopy. South Med J 1995;88:630-634.
[PubMed]
25.
Rembacken BJ, Axon AT: The role of pethidine in sedation for colonoscopy. Endoscopy 1995;27:244-247.
[PubMed]
26.
Cordruwisch W, Doroschko M, Wurbs D: Deep sedation in gastrointestinal endoscopic interventions: safety and reliability of a combination of midazolam and propofol (in German). Dtsch Med Wochenschr 2000;125:619-622.
[PubMed]
You do not currently have access to this content.