213 colonoscopies in propofol anesthesia: a safe and well tolerated method to improve patient satisfaction in a fee-for-service setting

Background: The general attitude towards colonoscopy is rather negative: fears of pain, discomfort and shame limit the acceptance of this procedure. Propofol deep anesthesia is a well established and extensively documented method to improve patient satisfaction and compliance.

Methods: All colonoscopies between February 2005 and February 2008 were included into statistical analysis of prospectively collected data on endoscopic diagnosis, type of invasion, complications, length of anesthesia and observation period; general conditions.

Results: 213 colonoscopy (123 men, 90 women, mean age 49.6+/-14.1 ys) were performed. All examinations were carried out in propofol deep anesthesia and were successful in terms of reaching the cecum. Endoscopic diagnoses were IBD (CD/UC) 17.9%, benign tumor 23.1%, cancer 3.1%, hemorrhoids 7.9%, diverticulosis 10.5%, aspecific inflammation 12.2%, others 7.4% and healthy 17.9%. Invasive interventions (e.g. polypectomy, biopsies) were performed in 66.2%. Colonoscopy related minor complications occurred in 1.9%, with only one case requiring re-hospitalization and blood-transfusions (Crohn's Disease patient with 72h post-intervention bleeding after terminal ileum biopsies). Minor complication related to anesthesia occurred in 3.8% (discomfort), and 1.9% required some from of symptom relief with medications. No referrals or hospitalization was necessary. The average time of anesthesia was 24.7+/-12.7min (including both operative and standard examinations). 88.7% of patients reported “fit & well“ subjective status following anesthesia, and only 12.7% have mainly minor complains (flatulence, abdominal pain, nausea). Average post-intervention observation period was 2.25+/-0.57 hrs.

Conclusion: Colonoscopy in propofol anesthesia is a safe method in the everyday out-patient setting for both diagnostic and invasive procedures. Mean hospital stay is 3 hours including colonoscopy and post-intervention observation.