S456 Immersive Virtual Reality During Un-Sedated Colonoscopy Is Safe and Workflow-Neutral, Providing a Drug-Free Platform for Future Analgesic Innovation—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Although pharmacologic sedation enhances comfort during colonoscopy, it also raises costs, prolongs recovery, and carries cardiopulmonary risk, so many centers continue to perform the procedure without sedatives. Immersive virtual-reality (VR) distraction offers a drug-free alternative that could modulate pain perception and anxiety by immersing patients in vivid, multisensory environments. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified randomized controlled trials (RCTs) evaluating Impact of Immersive Virtual Reality During Outpatient Sedation‐Free Colonoscopy through May 2025. Data were analyzed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at P < 0.05. Risk of bias was assessed using RoB 2.0. Results: In 3 randomized trials involving 205 patients undergoing unsedated colonoscopy (VR = 117, control = 88), immersive virtual-reality distraction showed no significant safety concerns, with adverse events occurring in 8/117 versus 13/88 participants (pooled risk ratio 0.53, 95% CI 0.24–1.17; I² = 0%). Procedural metrics were likewise unaffected: caecal-intubation time differed by only 0.13 min (–0.99 to 1.25; I² = 0%), and the likelihood of completing the examination without rescue sedation was similar (RR 0.73, 0.43–1.25; I² = 98%). However, patient-reported pain was higher with VR, with a pooled mean difference of +2.01 on a 10-point VAS (1.71–2.31; I² = 97%). Overall, immersive VR during unsedated colonoscopy appears feasible and procedurally neutral but does not reduce—and may increase—perceived discomfort, while posing no additional safety risks. Conclusion: Immersive VR proved seamlessly deployable—no added risk, no delay to cecal intubation—confirming real-world feasibility in the busy endoscopy suite. Although pooled pain scores trended higher, this likely reflects sub-optimal headset fit and generic content rather than any inherent limitation of VR technology. With iterative gains in ergonomics, personalized media, and coordinated endoscopist–patient communication, VR remains a scalable, drug-free strategy poised to elevate patient experience while preserving efficiency. Larger, standardized trials should now focus on these modifiable factors to unlock VR’s full analgesic potential in unsedated colonoscopy.