Colonoscopies play a vital role in detecting, diagnosing, and treating gastrointestinal conditions including colon cancer and inflammatory bowel disease. While this procedure is very common, the use of anesthesia during colonoscopy has been subject to debate. While one camp encourages anesthesia use to increase patient comfort and procedural ease, others may point to costs and potential risks of anesthesia. This is an ongoing debate which demonstrates the complicated questions and considerations when it comes to patient care and healthcare costs.  

There are three different ways anesthesia can be used for colonoscopy: moderate sedation, monitored anesthesia care (MAC) or deep sedation, and general anesthesia (Trummel, et al., 2017). Those on the supporting side of the debate cite that anesthesia during colonoscopy improves patient experience and satisfaction. This procedure can be extremely uncomfortable, and anesthesia or sedation allows patients to undergo a colonoscopy with decreased discomfort or anxiety. This also helps facilitate completion of the examination. Sedation with propofol has been shown to improve patient satisfaction and recovery, but less sedating medications such as benzodiazepines work well for patients with a low risk of adverse events (Trummel, et al., 2017).  

The benefits of anesthesia for colonoscopy for the proceduralist are also brought up in the debate. Anesthesia can streamline the colonoscopy procedure itself, minimizing interruptions due to patient discomfort or movement. It is associated with a higher completion rate (Lin, 2017). However, deep sedation has not been proven to increase polyp detection rates as compared to moderate sedation (Trummel, et al., 2017).  

Opponents of routine anesthesia usage in colonoscopy also have several valid points. One concern is the risks associated with anesthesia, particularly in populations that are more at-risk. While with proper screening, these complications are rare, they can still occur and may have detrimental effects on patients with certain underlying health conditions, such as obstructive sleep apnea (Trummel, et al., 2017).   

Cost is another factor considered in the debate over anesthesia in colonoscopy. The overall cost of a procedure increases if anesthesia is employed due to personnel, medication, and procedural costs. In 2012, it was estimated that it would cost 4.5 billion dollars over the next 10 years if anesthesia services were used for half of all colonoscopies (Trummel, et al., 2017). This debate also raises questions about cost effectiveness and resource allocation, especially if a healthcare system has limited resources. Routine anesthesia in colonoscopy may not always be justified if alternative sedation such as conscious sedation can achieve similar effects with lower costs and risks. While propofol is a safe and effective anesthetic for colonoscopy, it is harder to use due to access and cost issues (Lin, 2017).  

Furthermore, insurance companies have begun restricting coverage for anesthesia use during colonoscopy. They argue that patients with a low risk profile require moderate, not deep, sedation. Patients who may not qualify for deep sedation would be required to pay for this type of anesthesia out of pocket (Dayal, et al., 2024). This is a potentially concerning development given that deep sedation has known benefits in colonoscopy.  

Ultimately, as the demand for anesthesia during colonoscopy increases, the debate over its use reflects the complex dynamics of patient comfort, procedural efficiency, healthcare resource utilization, and patient autonomy (Trummel, et al., 2017). Anesthesia has large benefits in patient comfort and ease of procedure, but there are important and complex questions on risk and costs. Healthcare professionals and anesthetists must consider individual needs and preferences and engage in shared decision making when it comes to use of anesthesia during colonoscopy. Higher-risk patients who may have a more complex colonoscopy are a population where employment of anesthesia has a net positive effect. It is vital that healthcare professionals advocate for their patients who require or desire deep sedation to insure they receive coverage.  

References 

Lin, Otto S. “Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction.” Intestinal research vol. 15,4 (2017): 456-466. doi:10.5217/ir.2017.15.4.456 

McCluskey, Priyanka Dayal. “Blue Cross Colonoscopy Policy Prompts Outrage among Mass. Doctors.” WBUR News, WBUR, 12 Jan. 2024, www.wbur.org/news/2024/01/05/blue-cross-massachusetts-colonoscopy-anesthesia.  

Trummel, John Michael et al. “Anesthesia for Colonoscopy and Lower Endoscopic Procedures.” Anesthesiology clinics vol. 35,4 (2017): 679-686. doi:10.1016/j.anclin.2017.08.007 

Related posts:

Anesthesia for Electroconvulsive Therapy Epidural Nerve Blocks Merit-based Incentive Payment System (MIPS) Surgical Care Improvement Project (SCIP)