ORIGINAL ARTICLE: Clinical Endoscopy Unsedated colonoscopy: an option for some but not for all Silvia Paggi, MD, 1 Franco Radaelli, MD, 1 Arnaldo Amato, MD, 1 Gianmichele Meucci, MD, 2 Giancarlo Spinzi, MD, 1 Emanuele Rondonotti, MD, 1 Vittorio Terruzzi, MD 2 Milan, Italy Background: The increasing request for colonoscopy in clinical practice, coupled with the lack of time, has led to a renewed interest in unsedated procedures. Objective: To evaluate the acceptability of unsedated colonoscopy and to characterize the subset of patients more likely to undergo and complete the procedure without sedation and/or analgesia. Design: Prospective, population study. Setting: Nonacademic community hospital, 6-month observation period. Patients: Adult outpatients referred for colonoscopy were offered unsedated procedure, with the possibility of on-demand sedation. Interventions: Demographics, clinical features, and endoscopy outcomes were recorded. Data were analyzed by stepwise logistic regression analysis, and odds ratio (OR) and 95% confidence interval (CI) are given for significant variables. Main Outcome Measurements: Unsedated colonoscopy acceptance rate. Factors significantly associated with acceptance and completion of unsedated procedures. Results: The acceptance rate for unsedated colonoscopy was 56.2% of 964 consecutive evaluated patients. The cecal intubation rate in unsedated patients was 81.6% and increased to 97.3% with the option of on-demand sedation. At multivariate analysis, factors significantly associated with the acceptance were no previous colono- scopy (OR 1.52; 95% CI, 1.10-2.11), absent/low level of anxiety (OR 3.82; 95% CI, 2.71-5.38), and no concern about the examination (OR 1.80; 95% CI, 1.17-2.77). Fear of procedure-related pain was inversely associated with acceptance (OR 0.28; 95% CI, 0.17-0.35). Factors associated to drug-free colonoscopy completion were absence of preprocedure anxiety (OR 1.87; 95% CI, 1.08-3.21) and male sex (OR 3.59; 95% CI, 2.13-6.05). Limitations: Single-center study. Conclusion: The acceptance rate of unsedated colonoscopy is clinically relevant, and the procedure can be completed without sedation in the majority of patients. Subject-related factors may help to identify patients willing to undergo and potentially complete unsedated procedures. ( Gastrointest Endosc 2012;75:392-8.) The request for colonoscopy has dramatically increased in recent years, leading to an increase in costs, which are not adequately balanced by current resources. 1 In this clinical scenario, over and above the rapid recovery seda- tion regimens (propofol and fospropofol disodium), 2-4 re- cent consideration has been given to unsedated colonos- copy. Both of these strategies have a favorable impact on the turnover of endoscopy services, primarily reducing the recovery times. Unsedated colonoscopy has other poten- tial advantages over sedated procedures, such as elimina- tion of sedation-related costs and risks, avoidance of es- cort requirement, and activity restriction after the procedure. On the other hand, unsedated colonoscopy is generally perceived by patients as a painful and poorly Abbreviations: CI, confidence interval; OR, odds ratio. DISCLOSURE: The authors disclosed no financial relationships relevant to this publication. Copyright © 2012 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 doi:10.1016/j.gie.2011.09.015 Received May 23, 2011. Accepted September 8, 2011. Current affiliations: Gastroenterology Unit (1), Valduce Hospital, Como, Italy, Gastroenterology Unit (2), San Giuseppe Hospital, Milan, Italy. Reprint requests: Franco Radaelli, MD, Divisione di Gastroenterologia, Os- pedale Valduce, Via Dante 11, 22100 Como, Italy. 392 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 2 : 2012 www.giejournal.org