July, 2006

The Value of Colonoscopy
Nearly 14.2 million colonoscopies are performed yearly in the United States in 2002 (Seeff, Manninen, et al, 2004). The majority of colonoscopies are done to detect colon cancer, the second leading cause of cancer death in the U.S.

There are about 130,000 new cases and 57,000 deaths from colon cancer annually (Landis, Murray et al, 1999). According to the American Cancer Society, early detection can increase survival in colon cancer by 90%, but only 37% of colon cancers are detected early (Hoffmann, 2000).

Problems with Colonoscopy
Many patients avoid recommended sigmoidoscopies and colonoscopies out of fear of the procedure itself, or fear of what the procedure will find. Sometimes people simply don’t know about its potential benefits. Studies show that pre-colonoscopic anxiety is a significant problem. Providing people with information about the procedure can reduce anxiety and improve acceptance of the procedure (Bebbenslleben and Rohde, 1990; Luck, Pearson et al, 1999).

Distress due to intestinal cramping can make colonoscopy much harder for both patient and medical team. Severe anxiety sometimes prevents completion of the examination. But using intravenous (I.V.) sedation may cause hypoxia (low oxygen) and hypotension (low blood pressure) in some patients.

The Role of Relaxation and Imagery
Many studies have shown that relaxation with guided imagery, hypnosis, and/or music can reduce patient discomfort, raise patient tolerance of and satisfaction with the procedure, and reduce need for sedation in colonoscopies, endoscopies, and some vascular procedures (Bampton and Draper, 1997; Cadranel, Benhamou, et al, 1994; Harikumar, Rai, et al, 2006; Lang, Benotsch, et al, 2000; Lee, Chan, et al, 2002; Salmore and Nelson, 2000).

Reduced sedation during colonoscopy decreases complications, cuts the need for expensive monitoring, and allows patients and caregivers to quickly return to their daily lives (Cataldo, 1996). Increased satisfaction improves willingness to have future procedures, if needed.

Guided imagery is a safe, effective, and can increase patient compliance and satisfaction with colonoscopy, a procedure with known cost-effectiveness and outcome benefits. Guided imagery can reduce need for sedation, leading to direct cost savings and reduced chance of complications.

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Cataldo PA. Colonoscopy without sedation. Diseases of the Colon and Rectum. 1996; 3:257-61.

Harikumar R, Raj M, Paul A, Harish K, Kumar SK, Sandesh K, Asharaf S, Thomas V.Listening to music decreases need for sedative medication during colonoscopy: a randomized, controlled trial. Indian J Gastroenterol. 2006 Jan-Feb;25(1):3-5.

Hoffmann, C. Easing the Discomfort of Colonoscopy. WebMD Medical News. April 7, 2000.
Accessed July, 2006.

Landis SH, Murray T, Bolden S, Wingo PA. Cancer Statistics 1999. CA – A Cancer Journal for Clinicians. 1999 49(1): 8-31.

Lang E, Benotsch EG, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum KS, Logan H, Spiegel D. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet. 2000 355:1486-1490.

Lee DW, Chan KW, Poon CM, Ko CW, Chan KH, Sin KS, Sze TS, Chan AC. Relaxation music decreases the dose of patient-controlled sedation during colonoscopy: a prospective randomized controlled trial. Gastrointest Endosc. 2002 Jan;55(1):33-6.

Luck A, Pearson S, Maddern G, Hewett P. Effects of video information on precolonoscopy anxiety and knowledge: a randomised trial. Lancet. 1999 354(9195):2032-5.

Salmore RG, Nelson JP. The effect of preprocedure teaching, relaxation instruction, and music on anxiety as measured by blood pressures in an outpatient gastrointestinal endoscopy laboratory. Gastroenterol Nurs. 2000 23: 102-110.

Seeff LC, Manninen DL, Dong FB, Chattopadhyay SK,Nadel MR, Tangka FKL, Molinari NA, Is there endoscopic capacity to provide Colorectal Cancer screening to the unscreened population in the United States?, Gastroenterology. 2004;127:1661-1669.