- In this study, conscious sedation for routine colonoscopy was replaced with virtual reality (VR) in 27 patients, average age 64, who were told they could request standard pain medications at any time before or during the procedure
- 26 patients (96%) completed the procedure without pharmacologic rescue
- On scales of 1 (none) to 10 (extreme), those 26 patients rated their pre-procedure anxiety as an average of 3.8, procedural pain as 3.6 and discomfort as 4.0; the patient who discontinued VR rated procedural pain as 2
- The average satisfaction rating among patients who completed colonoscopy without medication was 7.3
- Average procedure time was comparable to the average for the four endoscopists who participated, and on a scale of 1 (poor) to 10 (excellent), those endoscopists rated their overall experience with VR as 8.6
Many patients delay or avoid colonoscopy because of the side effects of the sedative and narcotic medications and the need for an escort home. Yet non-sedated colonoscopy is not widely accepted.
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Madeline Friedman, grad student in the Division of Gastroenterology at Massachusetts General Hospital, Daniel Chung, MD, medical co-director of the Center for Cancer Risk Assessment and director of the High Risk GI Cancer Clinic in the Mass General Cancer Center, and colleagues recently conducted a pilot trial in which virtual reality (VR) was used as an alternative to narcotics. They report promising results in Endoscopy International Open.
Over a nine-month period, the researchers enrolled 27 individuals scheduled for screening/surveillance colonoscopy who had previously undergone at least one colonoscopy under conscious sedation. Their average age was 64.
The VR device, the Samsung Gear VR Oculus headset, was fitted to a Samsung Galaxy S7 smartphone. Participants were oriented to the device before the procedure and were told they could opt-out and request standard pain medications at any time before or during the procedure.
Multiple one- to seven-minute virtual experiences featuring nature and animal scenes were initiated just prior to colonoscope insertion and were delivered continuously throughout the procedure. The viewer was not required to move or direct any travel through the virtual environment. If a patient had to be repositioned, the care team communicated over the audio component of the VR.
A total of 26 patients (96%) completed the colonoscopy without requesting any medication. On scales of 1 (none) to 10 (extreme), these 26 patients rated their average pre-procedure anxiety as 3.8, procedural pain as 3.6 and discomfort as 4.0. The patient who discontinued VR rated procedural pain as 2.
The average satisfaction rating among patients who completed colonoscopy without medication was 7.3. When asked if they would choose VR instead of pain medication for future colonoscopies, 18 of the 26 patients (69%) said "yes", seven (27%) said "maybe" and one (4%) said "no."
Cecal intubation was achieved in all cases without adverse events. The average duration of the 26 colonoscopies without medication was 23 minutes, not significantly different from the average procedure time for the four endoscopists who participated (22 minutes).
On a scale of 1 (poor) to 10 (excellent), the endoscopists involved rated their experience with VR as 8.6.
Reasons to Pursue the Study of VR
Because the need for an escort and concerns about sedation are common barriers to obtaining colonoscopy, a non-pharmacological pain management strategy could make colonoscopy more accessible and ultimately, better utilized. VR is also safer than analgesia and is likely to be cost-saving (less medication cost, reduced time and resources required in the recovery room and reduced cost associated with missed work for both patient and escort).
Finally, opioid shortages have occurred due to supply chain disturbances. If it becomes necessary to prioritize indications for opioid use, screening colonoscopies would be considered low priority and VR could play an important role in helping them proceed.
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