Predictive Factors for Severe Insertion Pain During Unsedated Water Exchange Colonoscopy

Aims While WE colonoscopy generally results in less pain, some unsedated patients still experience significant abdominal pain during insertion. This study aimed to identify predictors of severe insertion pain in WE colonoscopy.

Methods A retrospective analysis was conducted on patients who had undergone unsedated WE colonoscopy at Dalin Tzu Chi Hospital. Logistic regression analyses were utilized to determine independent factors associated with severe insertion pain, defined as a pain score exceeding 5.

Results The study included 462 patients, of whom 291 were men and 171 were women, with a median age of 57 years. The median maximum pain score during the insertion phase was 0, with 50.2% of patients reporting no pain. Only 9.3% of patients reported experiencing severe pain during insertion. Although severe insertion pain was associated with a slightly longer insertion time (median: 16.3 vs. 14.3 minutes; P=0.016), it did not influence other colonoscopy outcomes. Multivariate logistic regression analysis identified female sex (odds ratio [OR]=2.503; 95% confidence interval [CI]=1.312–4.777; P=0.005) and a body mass index (BMI)<25 kg/m² (OR=2.065; 95% CI: 1.109–4.184; P=0.044) as factors significantly associated with severe pain. Female patients with a BMI<25 kg/m² had the highest incidence of severe pain (16.8%), compared to male patients with a BMI≥25, who had a markedly lower incidence (3.7%).

Conclusions In a non-sedative setting, female gender and a BMI below 25 kg/m² were significant predictors of severe insertion pain during WE colonoscopy. These findings may aid clinicians in identifying patients who could benefit from WE colonoscopy without sedation, thereby enhancing patient care and optimizing procedural planning.

Publication History

Article published online:
27 March 2025