Effect of Conscious Sedation with Midazolam and Fentanyl on the Overall Quality of Colonoscopy: a Prospective and Randomized Study

Background: a prospective, randomized study was conducted to assess the influence of conscious sedation on the overall quality of colonoscopy, simultaneously quantifying its effect on scientific quality, perceived quality and patient safety. Methods: patients referred for a colonoscopy were included. They were randomized to receive or not receive sedation. Demographic data, indication of colonoscopy, cecal intubation, introduction and withdrawal time, resected adenomas and complications during exploration were collected. Thirty days later, a satisfaction questionnaire was carried out (GHAA 9-me), and patients were asked about complications after the examination. Results: a total of 5328 patients were included (age 62 +/- 15.22 years, 47% male, 3734 sedated and 1594 without sedation). The sedated patients showed a shorter time of introduction of the endoscope (6.15 +/- 3.25 vs. 8,30 +/- 4,14 minutes; p < 0.01), higher rate of cecal intubations (96% vs. 88%, p < 0.05), longer withdrawal time (8.20 +/- 2.15 vs. 5.35 +/- 3.12 minutes; p < 0.01) and higher adenomas detection rates (22% vs. 17%, p < 0.05). The use of sedation reduced discomfort during and after the exploration without increasing the complications. The satisfaction questionnaire score was higher (23.6 +/- 1.5 vs. 16.6 +/- 4.8, p < 0.001) in the sedated patients. Conclusions: superficial sedation not only reduces patient discomfort but also improves the overall quality of colonoscopy. Therefore, we must consider the use of sedation as an essential part of colonoscopy.