THE COLONOSCOPY ? Study of related tolerance parameters

Context Colonoscopy plays an indubitable role in the setting of clinical practice, however, it is an invasive exam; complex, lengthy, embarrassing, not devoid of risks and discomfort that yields fear and anxiety in the majority of patients. In a new era of rising competition between health institutions, where the quality of health care and client satisfaction are praised, studies regarding tolerance-related colonoscopy issues yield great potential to be explored. In the present study, tolerance is defined as willingness to repeat the exam. Objectives Evaluate information associated to bowel preparation, the exam itself and post-examination period that might interfere with the tolerance to the colonoscopy. Methods Analysis of the tolerance to the colonoscopy at three stages (pre, post, and during) through a checklist: patient’s questionnaire and a medical assessment form were used. Results In this present study, 91.2% of 373 patients exhibited positive tolerance to the colonoscopy. Aspects related to a negative level of tolerance were patient gender (12.9% of women versus 3.2% of men would not repeat the exam), age extremes (less than 20 years and greater than 80 years of age), and abdominal pain, both during the bowel preparation and after the procedure. Conclusions Gender, age, patient cooperation and abdominal pain were the decisive components regarding tolerance to the colonoscopy. Notably, in two phases of the exam, the abdominal pain was the most important feature associated to a lessened tolerance. HEADINGS – Colonoscopy. Patient satisfaction. Abdominal pain. Department of Gastroenterology, Clinical Division, University of São Paulo School of Medicine, São Paulo, SP, Brazil. Correspondence: Dr. Cláudio Lyoiti Hashimoto – Av. Dr. Enéas de Carvalho Aguiar, 255 9o andar – s/9159 Cerqueira César 05403-000 São Paulo, SP, Brazil. E-mail: clhashimoto@uol.com. br doscopies considered patient acceptance to repeating the examination as an indirect measurement of tolerance(1, 9, 10, 21), few studies have explored the topic of tolerance in colonoscopy(14, 28, 30). Compliance to the medical treatment and practice is best attained through a contented patient. Tolerance is a key measure of this fulfillment, enabling such an intricate and subjective issue to be evaluated. Repeated medical visits with surveillance colonoscopies are necessary and critical in the follow-up of patients at higher risk for colorectal cancer, especially in cases of chronic inflammatory bowel disease(28). Patient compliance can be affected by the level of their comfort, confidence and satisfaction(5, 19). Patient cooperation during colonoscopy has such a considerable repercussion that his/her non-cooperation is considered an absolute contraindication for a colonoscopy(8). Likewise, low tolerance to colonoscopy was responsible for approximately 50% of incomplete examinations(15). Ussui VM, Silva ALW, Borges LV, Silva JGN, Zeitune JMR, Hashimoto CL. What are the most important factors regarding acceptance to the colonoscopy? Study of related tolerance parameters 24 Arq Gastroenterol v. 50 no. 1 jan./mar. 2013 Currently, the assessment of health care quality with respect to satisfaction, and exceeding the client’s expectation (patient) as an important marketing tool to attract new clients has become increasingly evident. The aims of the current study were to evaluate information associated with bowel preparation, the exam itself and post-examination period that might interfere with overall tolerance to the colonoscopy.