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Original article
Modifiable factors associated with patient-reported pain during and after screening colonoscopy
  1. Marek Bugajski1,2,
  2. Paulina Wieszczy2,3,
  3. Geir Hoff4,5,
  4. Maciej Rupinski1,2,
  5. Jaroslaw Regula1,2,
  6. Michal Filip Kaminski1,2,3,5
  1. 1 Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
  2. 2 Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
  3. 3 Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
  4. 4 Department of Research and Development, Telemark Hospital, Skien, Norway
  5. 5 Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Marek Bugajski, Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 02-781, Warsaw, Poland; marek.bugajski{at}


Objective Pain associated with colonoscopy is a major burden for patients. We investigated modifiable factors associated with patient-reported pain during and after colonoscopy.

Design This cross-sectional analysis included database records from 23 centres participating in a population-based colonoscopy screening programme in Poland. Colonoscopies were performed under three sedation modalities: none, benzodiazepine-opioid sedation or propofol sedation. We used Gastronet (a validated tool) to assess patients’ pain during and after colonoscopy; pain was scored on a four-point scale (no, little, moderate or severe pain), with moderate to severe defined as painful. We used multivariate logistic regression models to estimate ORs for painful colonoscopy and calculated risk-adjusted ratios of painful colonoscopies per endoscopist and compared it to the mean rate.

Results Of 35 216 screening colonoscopies in 2014 and 2015 included in our study, 22 725 (64.5%) patients returned valid Gastronet questionnaires. The proportion of examinations described as causing pain during (after) the procedure was 22.5% (14.2%) for unsedated, 19.9% (13.5%) for benzodiazepine-opioid sedation and 2.5% (7.5%) for propofol sedation. Propofol sedation, higher case volume of endoscopists, newest endoscope generation and adequate bowel preparation were significantly associated with lower odds of painful colonoscopy. Pain scores after colonoscopy showed similar associations. Adjusted pain rates during and after colonoscopy varied 11 and over 23-fold, respectively, between endoscopists.

Conclusion We identified several independent, modifiable factors associated with pain during and after colonoscopy, of which individual endoscopist was the most important. Dedicated training should be considered to decrease variability among endoscopists.

  • colonoscopy
  • abdominal pain
  • colorectal cancer screening

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  • Contributors MB, PW, GH, MR and JR, MFK: study design, data acquisition,analysis and interpretation; MB: writing the manuscript; PW, GH, MR, JR, MFK: manuscriptedition; GH: original Gastronet creation; MFK: polish Gastronet version adaptation.

  • Funding This work was funded by grant Pol-Nor/204233/30/2013 from the Polish-Norwegian Research Programme through the National Centre for Research and Development of Poland.

  • Competing interests MFK is on the advisory board of Alfa Wasserman and has spoken and taught for Olympus Poland. JR is on the advisory boards of Alfa Wasserman, Ipsen Pharma, Polpharma and Takeda and hasa travel grant from Abbvie. The other authors have no competing interests.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.