Risk stratification to predict pain during unsedated colonoscopy: results of a multicenter cohort study

Øyvind Holme; Michael Bretthauer; Thomas de Lange; Birgitte Seip; Gert Huppertz-Hauss; Ole Høie; Per Sandvei; Carl Magnus Ystrøm; Geir Hoff

doi:10.1055/s-0033-1344239

Endoscopy, Inhaltsverzeichnis

Endoscopy 2013; 45(09): 691-696
DOI: 10.1055/s-0033-1344239

Original article

Risk stratification to predict pain during unsedated colonoscopy: results of a multicenter cohort study

Øyvind Holme

¹Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway

²Institute of Health and Society, Department of Management and Health Economy, University of Oslo, Oslo, Norway

,

Michael Bretthauer

¹Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway

²Institute of Health and Society, Department of Management and Health Economy, University of Oslo, Oslo, Norway

³Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway

,

Thomas de Lange

⁴Department of Internal Medicine, Section of Gastroenterology, Bærum Hospital, Vestre Viken Hospital Trust, Rud, Norway

,

Birgitte Seip

⁵Department of Medicine, Vestfold Hospital Trust, Tonsberg, Norway

,

Gert Huppertz-Hauss

⁶Department of Medicine, Telemark Hospital Skien, Skien, Norway

,

Ole Høie

⁷Department of Medicine, Sorlandet Hospital, Arendal, Norway

,

Per Sandvei

⁸Department of Medicine, Østfold Hospital, Fredrikstad, Norway

,

Carl Magnus Ystrøm

⁹Department of Medicine, Innlandet Hospital Elverum, Elverum, Norway

,

Geir Hoff

²Institute of Health and Society, Department of Management and Health Economy, University of Oslo, Oslo, Norway

⁶Department of Medicine, Telemark Hospital Skien, Skien, Norway

¹⁰Cancer Registry of Norway, Oslo, Norway

› Institutsangaben

Abstract

Background and study aims: Colonoscopy without sedation has several advantages over sedated colonoscopy, but a considerable proportion of patients experience pain. The aim of this study was to develop a risk stratification model of pre-examination risk factors to enable targeted sedation during colonoscopy.

Patients and methods: Between October 2011 and January 2012, consecutive outpatients who were willing to start colonoscopy without sedation at 11 Norwegian centers were prospectively recruited. Patients recorded pain on a validated 4-point scale (none, slight, moderate, or severe pain). Potential risk factors for a painful procedure (defined as moderate or severe pain) were evaluated using multivariate logistic regression analyses, and the area under the receiver operating characteristics curve (AUROC) was calculated to assess the discriminatory ability of the derived model.

Results: A total of 1198 patients (635 men and 563 women) were included. Seven independent, pre-procedural risk factors for patient pain were identified: female sex, age < 40 years, previous abdominal surgery, abdominal pain as indication for colonoscopy, anticipation of pain, previous painful colonoscopy, and a history of diverticulitis. In patients with 0, 1, 2, or ≥ 3 risk factors, a painful colonoscopy was experienced by 35 %, 43 %, 52 %, and 63 % of women and 18 %, 24 %, 35 %, and 63 % of men, respectively. The model showed modest discrimination abilities (AUROC = 0.69).

Conclusion: Female sex was a strong risk factor for pain during colonoscopy, and sedation or analgesia should be considered for all women prior to colonoscopy. For male patients, the presence of multiple risk factors should encourage the endoscopist to offer sedation.

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Referenzen

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