People over the age of 50 are advised to undergo periodic colonoscopy, as a screening test for colon cancer. Most people who have a colonoscopy in the United States are sedated for the procedure, whereas in most other countries it is done without sedation. The advantages of a sedation-free procedure are that it takes less time, is much less expensive (because of a reduced need for equipment, facilities, and anesthesiologist and nurse time), and permits patients to resume their normal activities much more rapidly after the procedure is finished.
In a prospective study of 1,061 colonoscopy patients who were given the option of a sedation-free procedure, 36% agreed to try it. Of those, 94% completed the colonoscopy without sedation. Five factors were identified that could be used to predict which patients could successfully undergo the procedure without sedation. These factors were 1) male gender, 2) younger age, 3) endomorphic body type in women, 4) no prior hysterectomy, and 5) willingness to try the sedation-free procedure (with the assurance that at any point during the procedure the patients could change their mind and immediately receive sedation).

Comment: Some 60 million Americans are over the age of 50. At an average cost of $1,000 per colonoscopy, it would cost approximately $60 billion to screen this population just one time for colon cancer. With increasing numbers of insurers now agreeing to pay for routine colonoscopies, the added cost burden to the health-care system will be substantial. If all appropriate candidates were offered the sedation-free alternative, billions of dollars a year could be saved.

Jancin B. Identify candidates for sedation-free colonoscopy. Fam Pract News 2004(September 15):38.