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World J Gastrointest Endosc. Mar 16, 2010; 2(3): 81-89
Published online Mar 16, 2010. doi: 10.4253/wjge.v2.i3.81
Sedation-risk-free colonoscopy for minimizing the burden of colorectal cancer screening
Felix W Leung, Abdulrahman M Aljebreen, Emilio Brocchi, Eugene B Chang, Wei-Chih Liao, Takeshi Mizukami, Melvin Schapiro, Konstantinos Triantafyllou
Felix W Leung, Research and Medical Services, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA 91343, United States
Felix W Leung, Melvin Schapiro, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, United States
Abdulrahman M Aljebreen, King Khalid University Hospital, Riyadh 11461, Saudi Arabia
Emilio Brocchi, Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna 40136, Italy
Eugene B Chang, Department of Medicine, University of Chicago School of Medicine, Chicago, IL 60637, United States
Wei-Chih Liao, Department of Internal Medicine, National Taiwan University Hospital, Taibei, Taiwan, China
Takeshi Mizukami, Endoscopy Center, Yokohama Municipal Citizen’s Hospital, Yokohama 240-8555, Japan
Konstantinos Triantafyllou, Hepatogastroenterology Unit, 2nd Department of Internal Medicine - Propaedeutic, Attikon University General Hospital, Medical School, Athens University, Athens 11527, Greece
Author contributions: Leung FW reviewed pertinent literature, compiled the first and final draft of manuscript; Aljebreen AM, Brocchi E, Chang EB, Liao WC, Mizukami T, Schapiro M, Triantafyllou K provided critique of manuscript and commentary.
Correspondence to: Felix W Leung, MD, FACG, Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Division of Gastroenterology (111G) Sepulveda Ambulatory Care Center, VAGLAHS, 16111 Plummer Street, Sepulveda, CA 91343, United States.
Telephone: +1-818-8959403 Fax: +1-818-8959516
Received: August 17, 2009
Revised: January 30, 2010
Accepted: February 6, 2010
Published online: March 16, 2010

Unsedated colonoscopy is available worldwide, but is not a routine option in the United States (US). We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the use of unsedated colonoscopy for colorectal cancer screening. Medline data from 1966 to 2009 were searched to identify relevant articles on the subject. Data were summarized and co-authors provided critiques as well as accounts of unsedated colonoscopy for screening and surveillance. Diagnostic colonoscopy was initially developed as an unsedated procedure. Procedure-related discomfort led to wide adoption of sedation in the US, although unsedated colonoscopy remains the usual practice elsewhere. The increased use of colonoscopy for colorectal cancer screening in healthy, asymptomatic individuals suggests a reassessment of the burden of sedation in colonoscopy for screening is appropriate in the US for lowering costs and minimizing complications for patients. A water method developed to minimize discomfort has shown promise to enhance outcomes of unsedated colonoscopy. The use of scheduled, unsedated colonoscopy in the US appears to be feasible for colorectal cancer screening. Studies to assess its applicability in diverse practice settings deserve to be conducted and supported.

Keywords: Unsedated colonoscopy, Sedation-risk-free colonoscopy, Colon cancer screening