We conducted a randomized controlled trial including adults ≥18 years scheduled for outpatient, unsedated colonoscopy at the Endoscopy Unit of the Mohammed VI University Hospital, Marrakech. Patients with prior colorectal surgery, cognitive or sensory impairment, epilepsy, psychiatric disorders, or significant pre-procedural pain were excluded. Sixty patients were randomized (1:1) to receive either VR distraction plus routine care or routine care alone. Outcomes included procedural anxiety, pain, comfort, satisfaction, willingness to undergo future colonoscopies, and procedural characteristics. Validated scales were used for all patient-reported outcomes.

We performed a randomized trial of 60 adults undergoing unsedated colonoscopy, assigned to VR or control.Eligible patients were ≥18 years; major sensory, cognitive, surgical, or psychiatric contraindications were excluded.Anxiety, pain, comfort, satisfaction, and willingness to return were assessed using validated scales.Procedural metrics, including caecal intubation time, were recorded and compared between groups.

VR significantly improved multiple procedural metrics. Time to caecal intubation was reduced by 4.29 minutes in the VR group. Anxiety decreased more markedly with VR compared with controls (17.4→15.8 vs. 17.3→16.2). Pain was significantly lower with VR (mean 4.53 vs. 5.83), accompanied by a shift toward higher comfort ratings. Patient satisfaction was substantially higher with VR (74% vs. 54%), and the Net Promoter Score improved (–0.33 vs. –16.66). Willingness to return for future colonoscopy was also greater in the VR arm. Endoscopists reported high acceptability (mean score 8.3/10) and noted reduced procedural stress with minimal implementation difficulty.

VR significantly enhanced patient comfort, reduced pain and anxiety, and improved procedural efficiency and satisfaction during unsedated colonoscopy. Given its low cost, ease of implementation, and favorable user acceptance, VR represents a promising adjunct for routine use in endoscopy units as a non-pharmacological pain-relief and anxiolysis strategy.