Opinion
Support for no-sedation colonoscopy misses some significant drawbacks
LETTER — Posted Feb. 9, 2009
Regarding "Study supports use of no-sedation colonoscopy" (Article, Jan. 12): The study of unsedated colonoscopy claimed to have advantages for some patients in convenience and access to care. The patients attempting this procedure, however, had a 19% aborted procedure rate.
Patients had to reschedule and redo their entire GI prep -- no small inconvenience. I am guessing that most working patients would not appreciate the additional time off from work and juggling of their schedules -- more inconvenient, not less.
In addition, the authors did not address the discomfort experienced by the patients who were able to tolerate the procedure. Pain is now documented as a vital sign in hospitals and emergency rooms.
There was no mention of the percentage of patients who were able to undergo colonoscopy without sedation who would choose to do it that way again. Any patient with a bad experience will be more reluctant to repeat the procedure, defeating the purpose of screening.
The assertion that one cannot perforate the bowel of an awake patient is incorrect. The patient may be able to bring their discomfort to the physician's attention, but the performance of the procedure without sedation does not physically toughen the bowel wall.
Studies such as this give insurance companies ammunition to provide less care for their subscribers.
Mark F. Baucom, MD, Atlanta
Note: This item originally appeared at http://www.ama-assn.org/amednews/2009/02/09/edlt0209.htm.
