Dear Dr. Roach: After reading your recent column on sedation during colonoscopy, I wanted to mention that I have asked for no sedation during two colonoscopies in the past several years. I did this after reading an article in the newspaper. People commented with replies, many of which were of the “don’t bother with sedation” approach. Posters included doctors, nurses and patients.
I felt fine without any discomfort. Yes, I had moments that indeed felt somewhat like gas, but no pain, just some “pressure.” Benefits to no sedation included no aftereffect from drugs. I drove home from the procedure both times myself. I also had no anesthesiologist fees, which can cost more than the procedure in some cases. Finally, I am an interested patient, and I was able to view the procedure on the monitor while my doctor gladly commented and answered questions. I was offered a set of headphones and dark glasses if I wanted, but again, I was interested in knowing the medical details.
As a side note, I saw a study that determined that the longer the time taken during the inspection for polyps, the more that were found (fairly obvious, I guess). But I believe that when the patient is conscious, the doctor may tend to take more time, especially around turns, and may in fact take more time inspecting folds and creases. — D.S.
Answer: I appreciate your writing. There are people who take colonoscopy without sedation. Not everyone has as good an experience as yours.
During the procedure, gas is used to inflate the colon so the endoscopist can see. This causes a sense of fullness and distention that can be very uncomfortable for some people. However, your comments about the benefits may resonate with some readers. Personally, I find watching a colonoscopy fascinating — and the lining of the colon surprisingly beautiful — but I am quite sure not everyone will agree with you or me.
Your final point is important: Longer time during the “withdrawal” phase of the colonoscopy, which is when the gastroenterologist visually inspects the colon lining, means fewer missed polyps and other lesions. However, I am not sure that having a patient awake would motivate the physician to take a longer amount of time.
