The Influence of Endoscopist Experience

Sigmoidoscopy remains a vital tool for colorectal cancer screening. However, the endoscopist impact on pain often dictates the success of these unsedated procedures. A recent cross-sectional study analyzed over 23,000 sigmoidoscopies to determine why patient-reported pain varies so widely. Researchers found that while patient characteristics matter, the specific clinician performing the procedure is a dominant factor. Consequently, clinicians with more years of experience significantly reduced the odds of moderate to severe discomfort for their patients. Specifically, each additional year of experience decreased the pain rate by nearly 18%.

Clinical Consequences of Procedural Pain

Pain during a procedure is more than an unpleasant experience for the patient. Furthermore, high pain scores directly impacted the clinical efficacy of the examination. When patients experienced severe pain, completion rates dropped by nearly 67%. There was also a concerning trend toward a lower adenoma detection rate (ADR) in painful procedures. Therefore, minimizing pain is not just a matter of patient satisfaction but a critical quality indicator. Targeted training and consistent monitoring can help standardize performance across all endoscopists. This study underscores the need for ongoing quality assessment in screening programs.

Does the endoscopist impact on pain affect completion rates?

Yes, research shows that high levels of pain are strongly associated with lower examination completion rates. Specifically, patients reporting moderate or severe pain were significantly less likely to have a successful, complete procedure compared to those with minimal discomfort.

What are the independent predictors of pain in sigmoidoscopy?

Independent predictors of pain include the specific endoscopist's level of experience, female sex, and younger patient age. Clinical conditions such as the presence of diverticula or inflammatory bowel disease also significantly increase the likelihood of procedural pain.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Schult AL et al. Endoscopist as a key determinant of patient pain: a sigmoidoscopy screening model for unbiased assessment. Scand J Gastroenterol. 2026 Apr 14. doi: 10.1080/00365521.2026.2646941. PMID: 41981718.

Bugajski M, Wieszczy P, Hoff G, et al. Modifiable factors associated with patient-reported pain during and after screening colonoscopy. Gut 2018; 67(11): 1958–1964.

Ramakrishnan K, et al. Selecting patients for flexible sigmoidoscopy: Determinants of incomplete depth of insertion. Cancer 2005; 104(6): 1256-1262.