A colonoscopy is an exam that lets a gastroenterologist look closely at the inside of the entire colon and rectum for polyps, the small growths that over time can become cancer. Using a colonoscope, a thin, flexible, hollow, lighted tube that has a tiny video camera on the end, the doctor gently eases it inside the colon and sends pictures to a TV screen. The exam itself takes about 30 minutes. Patients are usually given light sedation administered by an anesthesiologist to help them relax and sleep while the procedure is performed.
Colonoscopies are now the most expensive screening test that healthy Americans routinely undergo, often costing more than an appendectomy in many developed countries. Their numbers have increased over the last 15 years, with more than 10 million Americans electing to have colonoscopies each year, according to Centers for Disease Control and Prevention, and this adds more than $10 billion in annual costs to the health care system.
Costs also increase if anesthesia services are provided for the 20 million colonoscopies and endoscopies performed each year. And more Americans are asking for anesthesia. According to a study in the Journal of the American Medical Association, 14% of people had an anesthesiologist or nurse anesthetist present during their procedures in 2003, but that number had jumped to 30% six years later. It’s also been estimated that payments to anesthesiologists for colonoscopy sedation quadrupled between 2003 and 2009, and that eliminating anesthesiologist services could save more than $ billion a year.
In order to deliver minimal-to-moderate sedation during a colonoscopy procedure without using the services of an anesthesiologist, a new computer-assisted personalized sedation device that delivers the prescription drug propofol for sedation via intravenous IV infusion was given premarket approval by the Food and Drug Administration in 2013. The novel technology is expected to empower health care facilities to more effectively use their limited resources to deliver greater value in the increasingly resource-constrained U.S. health care environment.
The new sedation system is a first-of-a-kind device in the world that allows non-anesthesia professionals to administer the drug propofol during colonoscopy and esophagogastroduodenoscopy (EGD) procedures as long as they have professional training and use the machine where there is immediate availability of an anesthesia professional.
The device can also be used for an EGD procedure, which is an in-office test to examine the lining of the esophagus, stomach, and first part of the small intestine. A physician-led team performs the EGD with a small camera that is inserted down the throat while the patient is sedated.
The pivotal study for the computerized sedation device demonstrated that healthy patients who were sedated using the device had lower occurrences of low blood oxygen levels (hypoxemia) compared to similarly healthy patients who were sedated with midazolam or a similar medication during elective colonoscopy and upper endoscopy procedures.
According to the American Society of Gastrointestinal Endoscopy, the innovative computer-assisted sedation system can reshape the world of endoscopic procedures, because it can administer propofol without a trained anesthesiologist on hand. Having an anesthesiologist for certain routine endoscopic procedures is expensive and this has limited the use of propofol, which is regarded as a superior sedative because it gets to work quickly and has a short half life that leads to faster recovery.
The new sedation system is expected to be introduced into clinical practice on a limited basis beginning in 2014.
Where Are They Now
These systems have cut the cost of sedation during a typical colonoscopy from $2,000 to about $250 with speedier recoveries and higher patient satisfaction. While there is lingering stigma about using a machine rather than a doctor, its success has inspired research into more advanced systems to be used for difficult and complicated procedures such as brain and heart surgery. The system received pre-market approval in May 2013. However, a class 1 recall of the device was issued in August 2015 and the computerized anesthesia system was discontinued in March 2016.