Skip to main content
SpringerLink
Log in

The Impact of Chronic Opioid Use on Colonoscopy Outcomes

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

An Erratum to this article was published on 19 May 2015

Abstract

Background

Endoscopic procedures are frequently performed on patients chronically on opioids, raising concerns about the safety and efficacy of conventional sedation.

Aims

We hypothesized that chronic opioid use is associated with longer procedure times, higher dosages of sedation medications, and an increase in adverse effects.

Methods

This is a retrospective review from June 2012 to June 2013. Patients on chronic opioids (opioids use ≥12 weeks) were compared to randomly selected patients matched for age, race, and sex. Multivariate regression analysis was performed to identify factors that were independently predictive of longer procedure times.

Results

Patients on chronic opioids required higher doses of fentanyl (122.0 ± 45.3 vs. 105.8 ± 47.2 µg; P < 0.0001) and midazolam (5.3 ± 5.3 vs. 4.4 ± 2 mg; P = 0.0037) and were more likely to receive diphenhydramine (42.8 vs. 22.6 %; P < 0.001). The induction period (11.3 ± 8.8 vs. 7.5 ± 4.0 min), duration of procedure (39.1 ± 17.5 vs. 33.4 ± 14.1 min), and recovery times (38.7 ± 15.3 vs. 33.8 ± 12.1 min) were significantly longer for patients on chronic opioids. In the multivariate regression analysis, opioid use was an independent predictor of longer procedure duration (P < 0.05). Hypotensive episodes did not differ between groups (2.8 vs. 2.7 %; P = 0.8). However, patients on chronic opioids experienced more pain (13.4 vs. 5.9 %; P 0.001) and hypertensive episodes (8.1 vs. 2.8 %; P 0.002).

Conclusion

Patients on chronic opioids represent a high-risk population with longer procedural times and more discomfort, despite higher dosages of sedative agents. Prospective studies are required to define the risks and benefits of more costly alternative sedation strategies for patients on chronic opioids.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Minoli G, Meucci G, Bortoli A, et al. The ASGE guidelines for the appropriate use of colonoscopy in an open access system. Gastrointest Endosc. 2000;52:39–44.

    Article  CAS  PubMed  Google Scholar 

  2. Davila RE, Rajan E, Baron TH. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006;63:546–557.

    Article  PubMed  Google Scholar 

  3. Seeff LC, Richards TB, Shapiro JA, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC’s survey of endoscopic capacity. Gastroenterology. 2004;127:1670–1677.

    Article  PubMed  Google Scholar 

  4. Blero D, Devière J. Endoscopic complications—avoidance and management. Nat Rev Gastroenterol Hepatol. 2012;9:162–172.

    Article  PubMed  Google Scholar 

  5. Quine M, Bell G, McCloy R, Charlton J, Devlin H, Hopkins A. Prospective audit of upper gastrointestinal endoscopy in two regions of England: safety, staffing, and sedation methods. Gut. 1995;36:462–467.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Bowles C, Leicester R, Romaya C, Swarbrick E, Williams C, Epstein O. A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? Gut. 2004;53:277–283.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Nelson DB, McQuaid KR, Bond JH, Lieberman DA, Weiss DG, Johnston TK. Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc. 2002;55:307–314.

    Article  PubMed  Google Scholar 

  8. Harewood GC, Wiersema MJ, Melton LJ III. A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy. Am J Gastroenterol. 2002;97:3186–3194.

    Article  PubMed  Google Scholar 

  9. Verma S, Fogel J, Beyda DJ, Bernstein B, Notar-Francesco V, Mohanty SR. Chronic methadone use, poor bowel visualization and failed colonoscopy: a preliminary study. World J Gastroenterol WJG. 2012;18:4350.

    Article  Google Scholar 

  10. Taylor C, Schubert ML. Decreased efficacy of polyethylene glycol lavage solution (golytely) in the preparation of diabetic patients for outpatient colonoscopy: a prospective and blinded study. Am J Gastroenterol. 2001;96:710–714.

    Article  CAS  PubMed  Google Scholar 

  11. Ure T, Dehghan K, Vernava A III, Longo W, Andrus C, Daniel G. Colonoscopy in the elderly. Surg Endosc. 1995;9:505–508.

    CAS  PubMed  Google Scholar 

  12. Chung Y, Han D, Yoo K-S, Park C. Patient factors predictive of pain and difficulty during sedation-free colonoscopy: a prospective study in Korea. Dig Liver Dis. 2007;39:872–876.

    Article  CAS  PubMed  Google Scholar 

  13. Sullivan MD, Edlund MJ, Fan M-Y, DeVries A, Brennan Braden J, Martin BC. Trends in use of opioids for non-cancer pain conditions 2000–2005 in commercial and Medicaid insurance plans: the TROUP study. Pain. 2008;138:440–449.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Daubresse M, Chang H-Y, Yu Y, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000–2010. Med Care. 2013;51:870–878.

    Article  PubMed  Google Scholar 

  15. Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain. 2012;13:715–724.

    Article  PubMed  Google Scholar 

  16. Rockville M. Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Treatment 2009.

  17. Research CoAP, Care, Research IoMCoAP, Medicine Io. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington: National Academies Press; 2011.

    Google Scholar 

  18. Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose a cohort study. Ann Int Med. 2010;152:85–92.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Pizzi LT, Toner R, Foley K, et al. Relationship between potential opioid-related adverse effects and hospital length of stay in patients receiving opioids after orthopedic surgery. Pharmacother J Hum Pharmacol Drug Therapy. 2012;32:502–514.

    Article  CAS  Google Scholar 

  20. Bal BS, Crowell MD, Kohli DR, et al. What factors are associated with the difficult-to-sedate endoscopy patient? Dig Dis Sci. 2012;57:2527–2534.

    Article  PubMed  Google Scholar 

  21. Bryson EO. The anesthetic implications of illicit opioid abuse. Int Anesthesiol Clin. 2011;49:67–78.

    Article  PubMed  Google Scholar 

  22. Seal KH, Shi Y, Cohen G, et al. Association of mental health disorders with prescription opioids and high-risk opioid use in US veterans of Iraq and Afghanistan. JAMA. 2012;307:940–947.

    CAS  PubMed  Google Scholar 

  23. Mosher HJ, Jiang L, Vaughan Sarrazin MS, Cram P, Kaboli PJ, Vander Weg MW. Prevalence and characteristics of hospitalized adults on chronic opioid therapy. J Hosp Med. 2014;9:82–87.

    Article  PubMed Central  PubMed  Google Scholar 

  24. QuickFacts A. US Census Bureau. 2010.

  25. Demyttenaere K, Bruffaerts R, Lee S, et al. Mental disorders among persons with chronic back or neck pain: results from the World Mental Health Surveys. Pain. 2007;129:332–342.

    Article  PubMed  Google Scholar 

  26. Sullivan M, Katon W. Somatization: the path between distress and somatic symptoms. APS J. 1993;2:141–149.

    Article  Google Scholar 

  27. McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc. 2008;67:910–923.

    Article  PubMed  Google Scholar 

  28. Shah HA, Paszat LF, Saskin R, Stukel TA, Rabeneck L. Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology. 2007;132:2297–2303.

    Article  PubMed  Google Scholar 

  29. Kim WH, Cho YJ, Park JY, Min PK, Kang JK, Park IS. Factors affecting insertion time and patient discomfort during colonoscopy. Gastrointest Endosc. 2000;52:600–605.

    Article  CAS  PubMed  Google Scholar 

  30. Radaelli F, Meucci G, Sgroi G, Minoli G. Technical performance of colonoscopy: the key role of sedation/analgesia and other quality indicators. Am J Gastroenterol. 2008;103:1122–1130.

    Article  PubMed  Google Scholar 

  31. Joseph EK, Reichling DB, Levine JD. Shared mechanisms for opioid tolerance and a transition to chronic pain. J Neurosci. 2010;30:4660–4666.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006;104:570–587.

    Article  CAS  PubMed  Google Scholar 

  33. Michelini S, Cassano G, Frare F, Perugi G. Long-term use of benzodiazepines: tolerance, dependence and clinical problems in anxiety and mood disorders. Pharmacopsychiatry. 1996;29:127–134.

    Article  CAS  PubMed  Google Scholar 

  34. Leung WD, Gelrud A. Ushering a New Era in gastroenterology: the flexible gastroscope. Dig Dis Sci. 2014;59:12–15.

    Article  PubMed  Google Scholar 

  35. Lee J, McCallion K, Acheson A, Irwin S. A prospective randomised study comparing polyethylene glycol and sodium phosphate bowel cleansing solutions for colonoscopy. Ulster Med J. 1999;68:68.

    PubMed Central  CAS  PubMed  Google Scholar 

  36. Terruzzi V, Meucci G, Radaelli F, Terreni N, Minoli G. Routine versus “on demand” sedation and analgesia for colonoscopy: a prospective randomized controlled trial. Gastrointest Endosc. 2001;54:169–174.

    Article  CAS  PubMed  Google Scholar 

  37. Froehlich F, Wietlisbach V, Gonvers J-J, Burnand B, Vader J-P. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European panel of appropriateness of gastrointestinal endoscopy European multicenter study. Gastrointest Endosc. 2005;61:378–384.

    Article  PubMed  Google Scholar 

  38. Bernstein C, Thorn M, Monsees K, Spell R, O’Connor JB. A prospective study of factors that determine cecal intubation time at colonoscopy. Gastrointest Endosc. 2005;61:72–75.

    Article  PubMed  Google Scholar 

  39. Wood J, Galligan J. Function of opioids in the enteric nervous system. Neurogastroenterol Motil. 2004;16:17–28.

    Article  PubMed  Google Scholar 

  40. Epstein FH, Stein C. The control of pain in peripheral tissue by opioids. N Engl J Med. 1995;332:1685–1690.

    Article  Google Scholar 

  41. Corley DA, Jensen CD, Marks AR, et al. Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs. Clin Gastroenterol Hepatol. 2013;11:172–180.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Sherer EA, Imler TD, Imperiale TF. The effect of colonoscopy preparation quality on adenoma detection rates. Gastrointest Endosc. 2012;75:545–553.

    Article  PubMed  Google Scholar 

  43. Glomsaker TB, Hoff G, Kvaløy JT, Søreide K, Aabakken L, Søreide JA. Patient-reported outcome measures after endoscopic retrograde cholangiopancreatography: a prospective, multicentre study. Scand J Gastroenterol. 2013;48:868–876.

    Article  PubMed  Google Scholar 

  44. Holme O, Bretthauer M, de Lange T, et al. Risk stratification to predict pain during unsedated colonoscopy: results of a multicenter cohort study. Endoscopy. 2013;45:691–696.

    Article  PubMed  Google Scholar 

  45. Sinicrope PS, Goode EL, Limburg PJ, et al. A population-based study of prevalence and adherence trends in average risk colorectal cancer screening, 1997 to 2008. Cancer Epidemiol Biomarkers Prev. 2012;21:347–350.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Vargo JJ, Bramley T, Meyer K, Nightengale B. Practice efficiency and economics: the case for rapid recovery sedation agents for colonoscopy in a screening population. J Clin Gastroenterol. 2007;41:591–598.

    Article  PubMed  Google Scholar 

  47. Aisenberg J, Brill JV, Ladabaum U, Cohen LB. Sedation for gastrointestinal endoscopy: new practices, new economics. Am J Gastroenterol. 2005;100:996–1000.

    Article  PubMed  Google Scholar 

  48. Hassan C, Rex D, Cooper G, Benamouzig R. Endoscopist-directed propofol administration versus anesthesiologist assistance for colorectal cancer screening: a cost–effectiveness analysis. Endoscopy. 2012;44:456–464.

    Article  CAS  PubMed  Google Scholar 

  49. Hoff G. Colonoscopy: sliding into the depths of sedation—is this what we want? Nat Rev Gastroenterol Hepatol. 2013;10:325–326.

    Article  PubMed  Google Scholar 

  50. Cohen LB, Wecsler JS, Gaetano JN, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol. 2006;101:967–974.

    Article  PubMed  Google Scholar 

  51. Koshy G, Nair S, Norkus EP, Hertan HI, Pitchumoni C. Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy. Am J Gastroenterol. 2000;95:1476–1479.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Section of Digestive Diseases, Department of Internal Medicine, University of Oklahoma Health Sciences Center, 920 Stanton Young Blvd. WP 1345, Oklahoma City, OK, 73104, USA

    Salman Nusrat, Sultan Mahmood, Hussein Bitar, William M. Tierney & Mohammad F. Madhoun

  2. Veterans Affair Medical Center, Oklahoma City, OK, USA

    Salman Nusrat, Sultan Mahmood, Hussein Bitar, William M. Tierney & Mohammad F. Madhoun

  3. Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA

    Klaus Bielefeldt

Authors
  1. Salman Nusrat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sultan Mahmood
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hussein Bitar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William M. Tierney
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Klaus Bielefeldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohammad F. Madhoun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Salman Nusrat.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nusrat, S., Mahmood, S., Bitar, H. et al. The Impact of Chronic Opioid Use on Colonoscopy Outcomes. Dig Dis Sci 60, 1016–1023 (2015). https://doi.org/10.1007/s10620-015-3639-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-015-3639-3

Keywords

Search

Navigation