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.

中文翻译：

---

与筛查结肠镜检查期间和之后患者报告的疼痛相关的可改变因素

目的 结肠镜检查相关的疼痛是患者的主要负担。我们调查了与结肠镜检查期间和之后患者报告的疼痛相关的可改变因素。设计 该横断面分析包括来自波兰参与基于人群的结肠镜筛查计划的 23 个中心的数据库记录。结肠镜检查在三种镇静方式下进行：无、苯二氮卓类阿片类镇静或丙泊酚镇静。我们使用 Gastronet（一种经过验证的工具）来评估结肠镜检查期间和之后患者的疼痛；疼痛按四分制（无、轻微、中度或重度疼痛）评分，中度至重度定义为疼痛。我们使用多变量逻辑回归模型来估计疼痛结肠镜检查的 OR，并计算每位内窥镜医师进行疼痛结肠镜检查的风险调整比率，并将其与平均比率进行比较。结果 在我们的研究中纳入的 2014 年和 2015 年的 35 216 次筛查结肠镜检查中，22 725 名（64.5%）患者返回了有效的 Gastronet 问卷。被描述为在手术期间（之后）引起疼痛的检查比例，未镇静的为 22.5% (14.2%)，苯二氮卓类阿片类镇静剂为 19.9% (13.5%)，丙泊酚镇静剂为 2.5% (7.5%)。丙泊酚镇静、内镜医师病例数较多、最新一代内窥镜和充分的肠道准备与结肠镜检查疼痛的几率较低显着相关。结肠镜检查后的疼痛评分显示出类似的关联。结肠镜检查期间和之后调整后的疼痛率在不同的内镜医师之间分别变化了 11 倍和 23 倍以上。结论 我们确定了几个与结肠镜检查期间和之后疼痛相关的独立的、可改变的因素，其中个体内窥镜医师是最重要的。应考虑进行专门的培训以减少内窥镜医师之间的差异。