Research Article

Predictive Feasibility Of Colonoscopy Without Sedation Using A Nomogram Model

DOI:

10.3791/69881

⸱

February 17th, 2026

 ,  ,  ,  ,  , 
1Department of Anorectal, Dongzhimen Hospital, Beijing University of Chinese Medicine, 2Department of Surgery, Beixiaguan Community Health Service Center in Haidian District, 3Department of Digestive, Dongzhimen Hospital, Beijing University of Chinese Medicine

In This Article

Summary

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This study identifies risk factors for incomplete unsedated colonoscopy and develops a nomogram model (area under the receiver operating characteristic curve = 0.886) to guide clinical decision-making for patient selection and intervention optimisation.

Abstract

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Colorectal cancer poses a global burden, and colonoscopy is an effective screening tool, with unsedated colonoscopy offering distinct advantages but facing completion challenges. A retrospective analysis of 745 patients who underwent unsedated colonoscopy between July 2021 and August 2022 was conducted, with participants divided into completion (n = 670) and incompletion (n = 75) groups. Univariate analysis revealed significant differences in gender, age, constipation history, anxiety grade, postoperative Visual Analogue Scale scores and examiner experience between groups. Multivariate logistic regression identified constipation (odds ratio [OR] = 4.981, 95% confidence interval [CI]: 2.755–5.633), high anxiety (OR = 8.499, 95% CI: 4.987–10.212) and examination by a less-experienced physician (OR = 3.319, 95% CI: 2.673–4.732) as independent risk factors. The constructed nomogram model demonstrated good predictive accuracy (Hosmer–Lemeshow test: χ2 = 4.561, p = 0.683) and discriminative ability (area under the receiver operating characteristic curve = 0.886, 95% CI: 0.749–0.970). This model enables clinicians to identify high-risk patients preoperatively, optimise examination plan selection (e.g. recommending sedation) or implement intensive interventions, thereby improving the completion rate of unsedated colonoscopy and enhancing patient experience.

Introduction

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Colorectal diseases are prevalent among digestive disorders, with colorectal cancer poised to become a substantial global burden. It is anticipated that the incidence will surge by 60% to over 2.2 million new cases and will result in more than 1.1 million deaths by 20301. Colonoscopy is recognised as an effective method for screening colorectal cancer, substantially reducing cancer risk2,3. In addition, colonoscopy enhances the diagnosis and management of inflammatory bowel disease4,5. Sedation allows patients to undergo the pro....

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Protocol

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This protocol adheres to the guidelines approved by the Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine (Ethics No. 2023DZMEC-043-02). All participants provided written informed consent prior to the study enrolment.

Patient selection

The study was conducted between 30 July 2021 and 1 August 2022 and involved patients undergoing unsedated colonoscopy at Beijing University of Chinese Medicine. The following inclusion criteria were applied: patients were aged 18–80 years; written informed consent to participate was provided; and one or more of the following cond....

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Results

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Comparison of clinical data between the two groups

A total of 745 patients underwent unsedated colonoscopy, including 220 patients with intermittent abdominal pain and 25 patients with a history of anxiety and taking anti-anxiety drugs, as shown in Figure 1. A total of 596 participants received an initial colonoscopy, and 149 participants received a repeat colonoscopy, with 65 receiving a sedation colonoscopy for the first time. A comparison of th.......

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Discussion

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The main reasons for incomplete unsedated colonoscopy include patients’ low tolerance of discomfort or pain and relatively poor bowel preparation. The study indicates that a patient’s history of constipation, the examining physician’s experience, and the patient’s anxiety level all play a role in the feasibility of performing unsedated colonoscopy. Of the 332 patients with constipation included in the study, 57 were unable to complete the unsedated procedure. Chronic constipation, manifested by sy.......

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Disclosures

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Not applicable.

Acknowledgements

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Not applicable.

....

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Materials

List of materials used in this article
NameCompanyCatalog NumberComments
Blood pressure monitorNot specifiedNot specifiedFor patient vital sign monitoring
Data collection sheetNot specifiedNot specifiedStandardized form for recording study data
Electronic colonoscopeOlympus (Japan)CF H260AIUsed for unsedated colonoscopy examination
Ottawa bowel preparation scaleNot specifiedNot specifiedUsed for bowel preparation quality evaluation
Oxygen supply equipmentNot specifiedNot specifiedEmergency supply for examination room
Polyethylene glycol electrolyte powder solutionNot specifiedNot specified4-L for bowel cleansing
Pulse oximeterNot specifiedNot specifiedFor patient oxygen saturation monitoring
R softwareR Foundation for Statistical ComputingVersion 4.2.0For nomogram model development (rms package)
Resuscitation equipmentNot specifiedNot specifiedEmergency supply for examination room
Self-rating anxiety scaleNot specifiedNot specified20-item scale for anxiety assessment
SPSS softwareIBMVersion 26.0For statistical analysis
Standard tape measureNot specifiedNot specifiedFor measuring abdominal circumference
StopwatchNot specifiedNot specifiedFor recording time to ileocecal junction
Visual Analogue Scale (VAS) assessment formNot specifiedNot specified10 cm scale for pain assessment

References

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  1. Arnold, M., et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 66 (4), 683-691 (2017).
  2. Doubeni, C. A., et al. Effectiveness of screening colonoscopy in reducing the risk of death....

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Tags

Unsedated ColonoscopyColonoscopy CompletionNomogram ModelColorectal Cancer ScreeningPredictive AccuracyLogistic RegressionAnxiety GradeConstipation HistoryExaminer ExperienceVisual Analogue Scale

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