Options for screening colonoscopy without sedation: a pilot study in United States veterans

Summary Background The direct and indirect costs of sedation limit access to screening colonoscopy amongst United States veterans. Aim To determine if offering the option of sedation on‐demand reduces the need for sedation. Design A retrospective review of prospectively collected performance improvement data in an open access screening colonoscopy programme. Setting Performance improvement programme to minimize the burden of sedation at a single VA Medical Center. Subjects 44 consecutive veterans who accepted the option of sedation on‐demand. They could choose to have premedications before the start of colonoscopy, or to begin colonoscopy without premedications and receive the medications upon their request during the examination. Method Two experienced endoscopists assisted by experienced nurse assistants performed all of the examinations. Insertion of the colonoscope was aided by infusion of warm water through the colonoscope without air insufflation. Medications were administered at the veterans’ request. Results Offering the option of sedation on‐demand to 44 consecutive veterans permitted 52% (N = 23) of the veterans to complete screening colonoscopy without any sedation. Conclusions This novel approach of sedation on‐demand and water infusion for screening colonoscopy deserves to be further evaluated in a randomized‐controlled study amongst patients undergoing colorectal cancer screening.