A non-randomised controlled trial comparing the use of conscious versus deep sedation in colonoscopy (CODSIC Trial)

Aims To identify and evaluate the various factors that may influence patient comfort and satisfaction during and after colonoscopy, with a particular focus on the type and depth of anaesthesia used.

Methods At our center, patients undergo colonoscopy under either deep sedation (propofol) or conscious sedation (midazolam/fentanyl). We carried out a prospective cross-sectional trial in which patients completed both pre- and post-endoscopy questionnaires. Anxiety levels were measured using GAD-7 scale, while both anticipated and experienced pain were rated on a Likert scale from 0 to 10. Procedure-specific details, including intubation and withdrawal times, were also collected [1] [2].

Results 90 patients underwent colonoscopy under conscious sedation whilst the remaining 138 received deep sedation (N=228). 56.7% were male and the average age was 56.8 years. Expected pain correlated better than pre-procedural anxiety levels to actual pain experienced (p=0.01 vs p=0.53). Propofol use led to better patient comfort (1.5 vs 3.2 /10; p<0.01) but this did not translate to higher satisfaction (9.3 vs 9.3 /10; p=0.94) or more willingness to repeat the procedure (p=0.34). Whilst having the procedure under deep sedation resulted in a higher completion rate (2 vs 6 incomplete; p=0.036) 8 patients in the deep sedation group experienced respiratory compromise compared to only 1 in the conscious sedation group (p=0.07).

Conclusions To date, few studies have compared patient comfort during colonoscopy using different types of anaesthesia within the same centre. Whilst deep sedation was found to be more comfortable for the patients, it also carried a higher risk of anaesthesia-related complications. Furthermore, other factors apart from comfort appear to influence overall satisfaction and the willingness to repeat the procedure in the future.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Takahashi Y, Tanaka H, Kinjo M, Sakumoto K.. Prospective evaluation of factors predicting difficulty and pain during sedation-free colonoscopy. Dis Colon Rectum 2005; 48 (6): 1295-1300
• 2 Xiong Y, Yan H, Qu L. et al. Global Trends of Gastrointestinal Endoscopy Anesthesia/Sedation: A Bibliometric Study (from 2001 to 2022). J Pain Res 2023; 16: 2393-2406 Published 2023 Jul 15