A Randomized Controlled Trial of Anoscopy and Manual Abdominal Compression to Increase Patient Comfort after Colonoscopy

Background/Aim: Colonoscopy may be associated with pain due to distension of colonic mesentery and air insufflation into the colonic lumen, although Sedo-analgesia may increase the tolerability of the procedure. This randomized, prospective, controlled study based on our clinical observations aimed to explore the sustainability of comfort provided by intraoperative sedation by allowing gas discharge via anoscopy while patients were still sedated.

Methods: The patients that underwent colonoscopy for colorectal cancer screening were considered for this study and a total of 100 patients were (61 male and 39 female) were included in this study. Colonoscopy procedures were carried out by two experienced endoscopists who are adequately trained. Following the colonoscopy, 50 patients in the study group were administered a disposable anoscope with sterile, water-soluble, lubricant gel while the effect of sedation was still maintained. Endoscopist compressed four abdominal quadrants for 5 seconds to evacuate gas and reduce distension during anoscopy. The anoscope was then removed and the patients were woken from anesthesia. The patients in the control group did not undergo anoscopy following a colonoscopy.

Results: Both groups were similar in terms of sex distribution, presence of polyps, procedural time, and midazolam and propofol doses. Only age was greater in the study group. Significant differences were detected between the mean pain scores of each of the three measurements (p<0.05). The anoscopy group had a significantly lower mean pain score.

Conclusion: Our study showed that pain and bloating were reduced at the end of the procedure and and 24th hours after the procedure when anoscopy was performed following a colonoscopy. Anoscopy group also had a higher proportion of patients accepting a repeat procedure (p<0.05). Even if not used on a routine basis, anoscopy may be used in select patients with excess distension after the colonoscopy procedure.