S4113 Virtual Reality as a Non-Pharmacologic Adjunct for Pain and Anxiety During an Unsedated Colonoscopy: Case Report

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Colonoscopy is the gold-standard and most common procedure for colorectal cancer screening, often performed under sedation to enhance patient comfort. However, sedation poses risks and requires post-procedural assistance, limiting access for individuals without transportation, social support, or with anesthesia contraindications. Virtual reality (VR) is a promising non-pharmacological tool for managing procedural pain and anxiety. We present a case demonstrating successful use of VR to facilitate unsedated colonoscopy in a patient with medical comorbidities and logistical barriers to sedation. Case Description/Methods: A 77-year-old woman with a history of breast cancer s/p lumpectomy and radiation therapy, obstructive sleep apnea, and hypertension presented for a routine surveillance colonoscopy given history of tubular adenomas. Lacking post-procedure transportation, she opted for an unsedated procedure, which revealed a fixed, angulated, and tortuous sigmoid colon with severe diverticulosis. Despite using the water immersion technique, the patient showed signs of distress, physical tension and discomfort, resulting in a challenging procedure. To improve tolerability, a VR headset displaying a calming lakeside sunset scene with soothing audio was introduced mid-procedure. Upon use, the patient reported complete pain relief and showed visible relaxation, allowing the procedure to continue smoothly. Two polyps were removed with cold snare and forceps polypectomy. Pathology revealed 1 sessile serrated polyp and 1 tubular adenoma. Post-procedurally, the patient expressed high satisfaction and willingness to repeat a colonoscopy with VR. Discussion: This case study highlights VR as a safe, non-pharmacologic, non-invasive tool for managing pain and anxiety during medical procedures when sedation is not feasible. VR acts as an immersive distraction tool, redirecting attention away from noxious stimuli by engaging multisensory input. The patient displayed both subjective (verbal reports of “no pain”) and objective (muscle relaxation) signs of relief, allowing scope advancement despite complex anatomy. This case illustrates that VR can support unsedated colonoscopy as a viable, well-tolerated option, even in complex cases, enhancing access and procedural efficiency. Further research is warranted to assess VR’s broader clinical use. The authors used ChatGPT solely to reword and rephrase text.