Sedation-risk-free colonoscopy for minimizing the burden of colorectal cancer screening

Table 2 Worldwide practice of sedation-risk-free colonoscopy

Endoscopist (location) (N)	Cecal intubation (%)	Special technique	Incomplete/difficult intubation	Predictor(s) of pain	Ref.
GI (Taiwan) (176)	97.70	Colonoscopy	Intolerance (n = 2), technical difficulty (n = 1), poor preparation (n = 1)	Female gender and the endoscopist	[22]
Surgeon (Taiwan) (109)	85.30		Previous gynecological surgery		[23]
GI (Italy) (510)	95.70	Oil, warm water vs air			[24]
GI (Korea) (426)	95.30		Older age, lower body mass index (BMI) and previous hysterectomy	Older age, lower BMI, hysterectomy, diarrhea, 1st time colonoscopy and anxiety	[25]
GI (Korea) (N = 244) (Low BMI n = 77)	97.7 (UE) vs 79.4 (C) (low BMI)	Upper endoscope (UE) vs Colonoscope (C)	9.3% (UE) vs 32.4% (C) (low BMI)	Use of C rather than UE	[26]
GI (France) (502)	78	Music	Pain, poor bowel prep		[27]
GI (Japan) (848)	99.60		Lower BMI, female, preparation status, previous hysterectomy	Lower BMI, younger age, intubation time, preparation status, previous hysterectomy	[29]
GI (Japan) (287)	96	Ultrathin vs pediatric or standard scope	looping in the ultrathin group, angulations or stricture in the pediatric and standard groups		[30]
GI (Saudi Arabia) (503)	67		Incomplete due to inadequate bowel prep (14.3%), due to pain (9.5%)		[31]
GI (Turkey) (120)	88			Mean pain score: 2.0 for the nonsedated and 3.8 for the sedated patients (P < 0.05)	[32]
GI (Croatia) (22)				2 of 22 patients in whom no sedation was used had oxygen saturation < 90 %	[33]
GI (Japan) (259)	95-96	Water instillation vs air insufflations		17.1% (water) and 33.3% (air) had abdominal pain (P < 0.001)	[34]
GI (Italy) (124)		On demand sedation (66% required sedation)		34% reported moderate or severe pain and 22% unwilling to repeat	[35]
GI (Norway) (409)	82 (90 willing to repeat)			Overall cohort: 5% very, 45% moderately, 50% not uncomfortable; 63% women vs 41% men, very or moderately uncomfortable	[36]
GI (Greece) (173)	92 unsedated, 87.9 success			Male gender, segmental colonic resection predict success	[37]
GI (Finland) (120)				After the procedure: midazolam vs placebo group (30 vs 40 mm; P < 0.05; visual analog scale, 0 to 100 mm: 0 = not at all, 100 = extremely)	[38]
GI (Germany) (100)	95 (87 willing to repeat)	As needed sedation (5%)		On a scale of 1 to 9, barium enema and colonoscopy produced similar ratings of discomfort (3.1 vs 3.2)	[39]
Surgeons (Singapore) (40)	78 (93 willing to repeat)	As needed sedation	23% required intravenous sedation	Thirty percent had no pain, 55% minimal pain, 8% moderate pain and 3% severe pain	[40]
GI (Japan) (467)	98-99	Variable stiffness (VSC) vs standard (CC)		Lower mean pain score was noted in VSC patients compared with CC patients	[45]