BACKGROUND: Despite increasing standardization of training and growing attention to quality in lower gastrointestinal endoscopy, patient-reported pain during sigmoidoscopy varies considerably. This study explored whether this variability arises from differences in endoscopist performance or patient characteristics. METHODS: This cross-sectional study included unsedated sigmoidoscopies performed between 2014 and 2019 within a population-based screening trial. Neither patients nor endoscopists selected each other. Pain was self-reported on a Likert scale: no pain, mild, moderate, severe. Patients were considered to have experienced pain if moderate or severe pain was reported. We used multivariable logistic regression to identify pain predictors, reporting odds ratios (ORs) and 95% confidence intervals (CI). RESULTS: A total of 23,483 sigmoidoscopies were performed (49.0% in men) by 47 endoscopists. Pain was reported by 607 (5.3%) men and 1612 (13.5%) women and varied substantially across endoscopists, ranging from 4.3 to 21.3%. Independent predictors of pain included young age, female sex, specific endoscopist, and presence of diverticula and inflammatory bowel disease. Greater endoscopist experience correlated with lower pain rate (OR 0.82 per additional year of experience, 95% CI 0.79-0.85). Pain was associated with lower examination completion rate (OR 0.33, 95% CI 0.29-0.37) and a trend towards a lower adenoma detection rate (ADR; OR 0.91, 95% CI 0.79-1.04). CONCLUSION: In this large study of unsedated sigmoidoscopies, the specific endoscopist strongly predicted patient-reported pain. Pain was linked to lower completion rates and ADR. Findings support ongoing quality monitoring and targeted training to minimize pain and improve outcomes. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01538550. Summarize the established knowledge on this subject.There is great inter-endoscopist variation in patient-reported pain during lower gastrointestinal endoscopy.Part of this variation may be attributable to case-mix differences, with more technically challenging procedures being performed by certain endoscopists.Unbiased studies are needed to clarify the endoscopist’s role in procedural pain.What are the significant and/or new findings of this study?This study provides a robust model for unbiased evaluation of procedural pain in lower GI endoscopy.Patient-reported pain varied widely and was strongly predicted by the individual endoscopist, despite immersive and standardised training, standardized endoscopy without sedoanalgesia, and no pre-endoscopy selection by patient or endoscopist preferences.Moreover, patient-reported pain was associated with lower completeness of examination and a trend toward reduced adenoma detection.The findings support systematic monitoring of quality indicators, with individualized supervision and targeted upskilling across endoscopy centres.
Schult et al. (Tue,) studied this question.