Procedure-Related Abdominal Discomfort in Patients Undergoing Colorectal Cancer Screening: A Comparison of Colonoscopy and Flexible Sigmoidoscopy

Abstract

OBJECTIVES: The aims of this study were to determine if there was a difference in procedure-related abdominal discomfort or willingness to return for subsequent screening examinations between patients undergoing colonoscopy and those undergoing flexible sigmoidoscopy. METHODS: Two groups were compared: patients referred for screening flexible sigmoidoscopy and patients referred for screening colonoscopy. All patients were asymptomatic for colorectal cancer. Four university-based gastroenterologists performed all procedures. Patients received conscious sedation for colonoscopy but not for flexible sigmoidoscopy. A research nurse blinded to the procedure performed and the study purpose administered a standardized telephone questionnaire assessing and quantifying peri-procedural discomfort. RESULTS: A cohort of 466 patients underwent screening examinations, and 87% were contacted subsequent to their examination. Procedure-related discomfort, postprocedural discomfort, or discomfort at either of these two times ("peri-procedural discomfort") occurred in 28% (68/243), 14% (34/243), and 36% (88/243) of patients undergoing colonoscopy, respectively. Procedure-related discomfort, postprocedural discomfort, or discomfort at either of these two times occurred in 58% (94/162), 16% (26/162), and 62% (100/162) of patients undergoing flexible sigmoidoscopy, respectively. Peri-procedural discomfort was significantly more common in patients undergoing flexible sigmoidoscopy than with colonoscopy (p < 0.0005). Patients undergoing screening colonoscopy were more willing to undergo the procedure again than those undergoing screening flexible sigmoidoscopy (p < 0.0005). CONCLUSIONS: Patients undergoing screening colonoscopy with conscious sedation are less likely to experience peri-procedural discomfort than those undergoing screening flexible sigmoidoscopy. Although most patients are willing to undergo subsequent screening examinations, patients undergoing screening colonoscopy are significantly more willing to undergo a subsequent examination than those undergoing screening flexible sigmoidoscopy.