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Scheduled, Unsedated Colonoscopy Provides Access to Colonoscopy in a VA Setting With Unexpected, Unplanned Discoveries


When a nursing shortage necessitated discontinuation of our conscious sedation program for colonoscopy,  scheduled, unsedated colonoscopy was offered to restore local access to colonoscopy. The option was accepted by one-third of the patients after the pros and cons of unsedated and sedated colonoscopy were explained. Interest in communication with the colonoscopist and lack of an escort were the most frequently cited reason for acceptance of the unsedated option. Initial cecal intubation rate was <80%, limited by discomfort. A searching of the literature for methods to minimize discomfort led to the discovery of several water-related techniques. Based on these techniques, a water infusion in lieu of air insufflation (water method) for aiding colonoscope insertion was developed. In  a consecutive group non-randomized observational study, the er method significant improved cecal intubation rate to 97