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Review
. 2024 Oct 5:17:26317745241282576.
doi: 10.1177/26317745241282576. eCollection 2024 Jan-Dec.

Causes of intraprocedural discomfort in colonoscopy: a review and practical tips

Jabed F Ahmed  1   2 , Ara Darzi  2 , Lakshmana Ayaru  3 , Nisha Patel  3   2
Affiliations
Review

Causes of intraprocedural discomfort in colonoscopy: a review and practical tips

Jabed F Ahmed et al. Ther Adv Gastrointest Endosc. .

Abstract

Colonoscopy is a commonly performed procedure in the United Kingdom and the gold standard for diagnosis and therapy in the gastrointestinal tract. Increased levels of pain during colonoscopy have been associated with reduced completion rates and difficulties in maintaining attendance for repeat procedures. Multiple factors play a role in causing discomfort intra-procedurally: patient factors, such as gender, anatomy and pre-procedure anxiety; operator factors, such as patient position and level of experience and other factors, such as bowel preparation and total procedure time. A literature search was performed to identify papers that explained how patient, operator and endoscopy factors influenced pain and discomfort in endoscopy. A further search then also identified papers describing solutions to pain and discomfort that have been explored. After review of the literature, key methods are selected and discussed in this paper. Solutions and aids that can resolve and improve pain and discomfort include endoscopic methods such as variable stiffness and ultrathin scopes. Operator improvements in techniques and ergonomics alongside the use of newer technologies such as propelled endoscopy, computer-assisted endoscopy and task distraction. To improve patient experience and outcomes, the investigation and research into improving techniques to reduce pain is crucial. This review aims to identify the modifiable and non-modifiable factors associated with intra-procedural discomfort during colonoscopy. We discuss established methods of improving pain during colonoscopy, in addition to newer technologies to mitigate associated discomfort.

Keywords: colonoscopy; discomfort; endoscopy factors; novel solutions; pain; patient factors.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Deformation of the colon; types that occur in colonoscopy. Source: Adapted from Takahashi et al.
Figure 2.
Figure 2.
Endoscopy technique principles.
Figure 3.
Figure 3.
Summary of new and novel techniques being used to improve discomfort.
See this image and copyright information in PMC

References

    1. Harris A. Position statement produced by BSG, AUGIS and ACPGBI guidance on the indications for diagnostic upper GI endoscopy, flexible sigmoidoscopy and colonoscopy. https://www.bsg.org.uk/wp-content/uploads/2019/12/indications_diagnostic... (2019, accessed 5 October 2023).
    1. Rees C, Thomas Gibson S, Rutter M, et al. UK key performance indicators and quality assurance standards for colonoscopy. Gut 2016; 65: 1923–1929. - PMC - PubMed
    1. Bugajski M, Wieszczy P, Hoff G, et al. Modifiable factors associated with patient-reported pain during and after screening colonoscopy. Gut 2018; 67(11): 1958–1964. - PubMed
    1. Aljebreen AM, Almadi MA, Leung FW. Sedated vs unsedated colonoscopy: a prospective study. World J Gastroenterol 2014; 20(17): 5113–5118. - PMC - PubMed
    1. Hoffman MS, Butler TW, Shaver T. Colonoscopy without sedation. J Clin Gastroenterol 1998; 26(4): 279–282. - PubMed

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