S1227 Immersive Virtual Reality Reduces Pain and Anxiety During Unsedated Colonoscopy: A Meta-Analysis

Introduction: Colonoscopy remains a cornerstone of colorectal cancer prevention, but the mitigation of procedural discomfort through sedation carries well-known cardiopulmonary risks (e.g., hypoxemia, aspiration) and imposes additional cost and logistical burdens. Furthermore, sedation is not always available or desired in certain patients or settings, and unsedated colonoscopy offers faster recovery and patient independence, but pain and anxiety often impede its implementation. Immersive virtual reality (VR) offers a novel, distraction-based approach to improve patient comfort by redirecting attention to a 3D immersive environment. Early studies and a qualitative review have suggested that VR can reduce colonoscopy pain and anxiety, but no prior quantitative synthesis has confirmed these benefits. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials comparing immersive VR to standard care during unsedated colonoscopy. PubMed, Cochrane Library, and Google Scholar were searched (2005–2025). Eligible studies enrolled adults undergoing colonoscopy without sedation and used head-mounted VR during the procedure. Screening followed PRISMA 2020 guidelines. Pain and anxiety outcomes were pooled as standardized mean differences (SMDs) using a random-effects model. Heterogeneity was assessed with I². Sensitivity analyses excluded studies with imputed values. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: VR significantly reduced procedure-related pain (pooled SMD –1.07, 95% CI –1.57 to –0.56) and anxiety (SMD –0.81, 95% CI –1.27 to –0.34) compared to standard care, with moderate heterogeneity (I² = 66% and 62%, respectively). All trials reported improved patient comfort with VR, and no VR-related adverse events occurred. Sensitivity analyses excluding a study with imputed data continued to show significant pain and anxiety reductions, reinforcing the robustness of the results. VR users also reported higher satisfaction and willingness to repeat the procedure, and VR did not prolong or impair the exam, demonstrating its feasibility and acceptability. Conclusion: This is the first meta-analysis to demonstrate that immersive VR is a safe and effective nonpharmacologic adjunct that markedly improves patient experience and procedural tolerance during unsedated colonoscopy. Through mitigating pain and anxiety without medication, VR could facilitate broader adoption of sedation-free colonoscopy, expanding access to screening while avoiding sedation-related risks and burdens.