Introduction Patients often find endoscopic procedures difficult to tolerate. This may reflect actual “discomfort” of the procedure (eg, due to abdominal bloating) or distress (eg, related to intubation). While previous studies have identified factors that may influence procedural tolerability, no study has tried to discriminate specifically between discomfort and distress. We sought to prospectively evaluate these outcomes in patients undergoing colonoscopy, flexible sigmoidoscopy and gastroscopy.

Methods Consecutive patients attending a tertiary referral centre for clinically indicted endoscopic examination were prospectively recruited between August and December 2011. Sex, age, body mass index (BMI) and previous endoscopy experience were recorded. Procedural completion time, quality of bowel preparation and endoscopic findings were also documented. Patients were asked to grade anticipated and actual procedural discomfort and distress scores using a previously validated Numeric Rating Scale ranging form 0-10 as well as being asked to complete a Hospital Anxiety and Depression Scale. Patients also provided qualitative data, providing insights into their perceptions on perceived distress or discomfort. Data were analysed using SPSS version 19 with T-test analysis undertaken.

Results 271 patients were prospectively recruited (127 male, 144 female; median 56 years, range 17–89 years). Of these, 124 patients had a gastroscopy, 116 underwent colonoscopy and 31 had flexible sigmoidoscopy examinations. 34 patients (12.5%) underwent bi-directional endoscopy. Analysis showed that discomfort scores were significantly higher in patients undergoing colonoscopy compared to gastroscopy (4.65 vs 2.90, p<0.001) and also when comparing flexible sigmoidoscopy to gastroscopy (4.10 vs 2.90, p=0.047). No difference was identified when comparing flexible sigmoidoscopy discomfort levels to colonoscopy (p=0.365). Interestingly, while discomfort scores were significantly lower in the gastroscopy group, overall distress levels were significantly higher in this group compared to the colonoscopy group (3.99 vs 3.16, p=0.049). Data provided from the qualitative analysis would suggest that this is primarily due to the distress caused by oesophageal intubation.

Conclusion This is the first study to discriminate between distress and discomfort in endoscopic procedures and highlights variations in tolerability dependent on the underlying procedure undertaken. Our observations provides evidence to suggest greater attention should be made by endoscopists during oesophageal intubation during gastroscopy and with regards to gas insufflation during lower gastrointestinal endoscopic examinations.

Competing interests None declared.