Should patients be recording a pain score during colonoscopy?

Review by Prof. Shanil Kadir (Pakistan)

Study Summary 

Patient experience is one of the key performance indicators for colonoscopy. It is measured by using Gloucester Comfort Scale (GCS), which is measured by clinicians. Since there is no standardized approach for this, preliminary studies have suggested that clinician-reported GCS scores may not accurately reflect the colonoscopy experience from the patient’s perspective. Consequently, there is a lack of specific insights regarding the extent of discrepancy between clinician-reported GCS scores and patient-reported experience in terms of colonoscopy-related discomfort and pain. Recently, a new patient-reported experience measure (PREM) for gastrointestinal endoscopy was developed and validated: the Newcastle ENDOPREM which provides comprehensive insights into a patient’s endoscopy experience and can help compare clinician and patients’ perspective of pain.

Adult patients undergoing colonoscopy at two centers in Amsterdam from July 2023 to Feb 2024. Exclusion criteria included patients receiving propofol, having a sigmoidoscopy, having a history of colorectal surgery and those who reported no discomfort. The endoscopists were unaware of the study. 579 patients were invited out of which 312 returned the Newcastle ENDOPREM questionnaire. 69 patients were excluded due to incomplete questionnaires and/or consent form not signed.

Physician reported GCS score frequently underestimated the discomfort and pain experienced by the patients and poorly reflected the colonoscopy experience of the patients. Use of the PREMs questionnaire could help reduce the underestimation of the patient discomfort and pain, thereby, improving the patients experience of colonoscopy.

Commentary 

The study is the first study to compare clinician and patient reported scores for pain and discomfort during colonoscopy and adds to the evidence that clinician and patient perceptions of discomfort, pain levels and procedure tolerability do not match. Factors which are associated with moderate to significant pain were female sex, age <55 years and diverticulosis of the sigmoid colon. The weakness of the study was the sample size and response bias from the patients. There could also have been recall bias as the cutoff for submission was 30 days. Overall, the study highlights the importance of recording patient perception of their discomfort in order to provide a better experience.

Citation

Van Bokhorst QNE, Geerlings V, van der Vlugt M, et al. Clinician-reported Gloucester Comfort Scale scores underestimate patient discomfort and pain during colonoscopy: insights from comparison with a patient-reported experience measure. Endoscopy 2025;57: 645 – 657. DOI: 10.1055/a-2528-5578

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