PMID- 28970289
OWN - NLM
STAT- MEDLINE
DCOM- 20181105
LR  - 20181105
IS  - 1468-3288 (Electronic)
IS  - 0017-5749 (Linking)
VI  - 67
IP  - 11
DP  - 2018 Nov
TI  - Modifiable factors associated with patient-reported pain during and after
      screening colonoscopy.
PG  - 1958-1964
LID - 10.1136/gutjnl-2017-313905 [doi]
AB  - OBJECTIVE: Pain associated with colonoscopy is a major burden for patients. We
      investigated modifiable factors associated with patient-reported pain during and 
      after colonoscopy. DESIGN: This cross-sectional analysis included database
      records from 23 centres participating in a population-based colonoscopy screening
      programme in Poland. Colonoscopies were performed under three sedation
      modalities: none, benzodiazepine-opioid sedation or propofol sedation. We used
      Gastronet (a validated tool) to assess patients' pain during and after
      colonoscopy; pain was scored on a four-point scale (no, little, moderate or
      severe pain), with moderate to severe defined as painful. We used multivariate
      logistic regression models to estimate ORs for painful colonoscopy and calculated
      risk-adjusted ratios of painful colonoscopies per endoscopist and compared it to 
      the mean rate. RESULTS: Of 35 216 screening colonoscopies in 2014 and 2015
      included in our study, 22 725 (64.5%) patients returned valid Gastronet
      questionnaires. The proportion of examinations described as causing pain during
      (after) the procedure was 22.5% (14.2%) for unsedated, 19.9% (13.5%) for
      benzodiazepine-opioid sedation and 2.5% (7.5%) for propofol sedation. Propofol
      sedation, higher case volume of endoscopists, newest endoscope generation and
      adequate bowel preparation were significantly associated with lower odds of
      painful colonoscopy. Pain scores after colonoscopy showed similar associations.
      Adjusted pain rates during and after colonoscopy varied 11 and over 23-fold,
      respectively, between endoscopists. CONCLUSION: We identified several
      independent, modifiable factors associated with pain during and after
      colonoscopy, of which individual endoscopist was the most important. Dedicated
      training should be considered to decrease variability among endoscopists.
CI  - (c) Article author(s) (or their employer(s) unless otherwise stated in the text
      of the article) 2018. All rights reserved. No commercial use is permitted unless 
      otherwise expressly granted.
FAU - Bugajski, Marek
AU  - Bugajski M
AD  - Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial
      Cancer Centre, Institute of Oncology, Warsaw, Poland.
AD  - Department of Gastroenterology, Hepatology and Oncology, Medical Center for
      Postgraduate Education, Warsaw, Poland.
FAU - Wieszczy, Paulina
AU  - Wieszczy P
AD  - Department of Gastroenterology, Hepatology and Oncology, Medical Center for
      Postgraduate Education, Warsaw, Poland.
AD  - Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer
      Centre, Institute of Oncology, Warsaw, Poland.
FAU - Hoff, Geir
AU  - Hoff G
AD  - Department of Research and Development, Telemark Hospital, Skien, Norway.
AD  - Department of Health Management and Health Economics, University of Oslo, Oslo,
      Norway.
FAU - Rupinski, Maciej
AU  - Rupinski M
AD  - Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial
      Cancer Centre, Institute of Oncology, Warsaw, Poland.
AD  - Department of Gastroenterology, Hepatology and Oncology, Medical Center for
      Postgraduate Education, Warsaw, Poland.
FAU - Regula, Jaroslaw
AU  - Regula J
AD  - Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial
      Cancer Centre, Institute of Oncology, Warsaw, Poland.
AD  - Department of Gastroenterology, Hepatology and Oncology, Medical Center for
      Postgraduate Education, Warsaw, Poland.
FAU - Kaminski, Michal Filip
AU  - Kaminski MF
AD  - Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial
      Cancer Centre, Institute of Oncology, Warsaw, Poland.
AD  - Department of Gastroenterology, Hepatology and Oncology, Medical Center for
      Postgraduate Education, Warsaw, Poland.
AD  - Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer
      Centre, Institute of Oncology, Warsaw, Poland.
AD  - Department of Health Management and Health Economics, University of Oslo, Oslo,
      Norway.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20170928
PL  - England
TA  - Gut
JT  - Gut
JID - 2985108R
RN  - 0 (Hypnotics and Sedatives)
RN  - 12794-10-4 (Benzodiazepines)
RN  - YI7VU623SF (Propofol)
SB  - AIM
SB  - IM
MH  - Benzodiazepines/administration & dosage/adverse effects
MH  - Colonoscopy/*adverse effects/methods
MH  - Colorectal Neoplasms/diagnosis
MH  - Cross-Sectional Studies
MH  - Databases, Factual
MH  - Early Detection of Cancer/adverse effects/methods
MH  - Female
MH  - Humans
MH  - Hypnotics and Sedatives/administration & dosage/adverse effects
MH  - Male
MH  - Middle Aged
MH  - Pain Measurement/methods
MH  - Pain, Postoperative/drug therapy/*epidemiology/etiology
MH  - Pain, Procedural/drug therapy/*epidemiology/etiology
MH  - Patient Reported Outcome Measures
MH  - Poland
MH  - Propofol/administration & dosage/adverse effects
MH  - Risk Factors
MH  - Surveys and Questionnaires
OTO - NOTNLM
OT  - *abdominal pain
OT  - *colonoscopy
OT  - *colorectal cancer screening
COIS- Competing interests: MFK is on the advisory board of Alfa Wasserman and has
      spoken and taught for Olympus Poland. JR is on the advisory boards of Alfa
      Wasserman, Ipsen Pharma, Polpharma and Takeda and hasa travel grant from Abbvie. 
      The other authors have no competing interests.
EDAT- 2017/10/04 06:00
MHDA- 2018/11/06 06:00
CRDT- 2017/10/04 06:00
PHST- 2017/02/06 00:00 [received]
PHST- 2017/07/31 00:00 [revised]
PHST- 2017/09/07 00:00 [accepted]
PHST- 2017/10/04 06:00 [pubmed]
PHST- 2018/11/06 06:00 [medline]
PHST- 2017/10/04 06:00 [entrez]
AID - gutjnl-2017-313905 [pii]
AID - 10.1136/gutjnl-2017-313905 [doi]
PST - ppublish
SO  - Gut. 2018 Nov;67(11):1958-1964. doi: 10.1136/gutjnl-2017-313905. Epub 2017 Sep
      28.