Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice: a randomized trial (original) (raw)
Related papers
Patient tolerance and acceptance of unsedated ultrathin esophagoscopy
Gastrointestinal Endoscopy, 2002
Background: Unsedated endoscopy has not gained wide acceptance in the United States. Factors that may predict tolerance and acceptance of unsedated endoscopy are ill defined. Methods: Outpatients referred for standard EGD were recruited to undergo unsedated ultrathin esophagoscopy (UUE) with a new 3.1-mm battery-powered esophagoscope before sedated EGD. They rated preprocedure and postprocedure anxiety levels with the Profile of Mood States Tension/Anxiety subscale (POMS-SF T/A). They also rated symptoms and overall acceptability and listed procedural preference between EGD and UUE. Patients who refused UUE noted a reason for refusal and also completed the anxiety questionnaire. Results: Fifty-two of 98 patients recruited agreed to participate, and underwent both UUE and EGD. Patients who refused UUE were significantly more anxious (mean anxiety score, 8.2 vs. 4.5, p < 0.005). Participants reported no significant difference between preprocedural (4.6 vs. 5.3) or postprocedural (3.5 vs. 2.6) anxiety for UUE versus standard EGD. After undergoing both procedures, only 46% stated they would prefer UUE to EGD in the future. Patients who chose the peroral approach were more likely to prefer UUE than those who chose the transnasal approach (58% vs. 23%, p = 0.02).
World journal of gastrointestinal endoscopy, 2013
To evaluate the effects of choice of insertion route and ultrathin endoscope types. This prospective study (January-June 2012) included 882 consecutive patients who underwent annual health checkups. Transnasal esophagogastroduodenoscopy (EGD) was performed in 503 patients and transoral EGD in 235 patients using six types of ultrathin endoscopes. Patients were given a choice of insertion route, either transoral or transnasal, prior to EGD examination. For transoral insertion, the endoscope was equipped with a thin-type mouthpiece and tongue depressor. Conscious sedation was not used for any patient. EGD-associated discomfort was assessed using a visual analog scale (VAS; no discomfort 0- maximum discomfort 10). Rates of preference for transnasal insertion were significantly higher in male (male/female 299/204 vs 118/117) and younger patients (56.8 ± 11.2 years vs 61.3 ± 13.0 years), although no significant difference was found in VAS scores between transoral and transnasal insertion ...
Upper gastrointestinal endoscopy: Are preparatory interventions effective?
Gastroenterology Nursing, 1999
AIM: The fears and concerns are associated with gastroscopy (EGD) decrease patient compliance. Conscious sedation (CS) and non-pharmacological interventions have been proposed to reduce anxiety and allow better execution of EGD. The aim of this study was to assess whether CS, supplementary information with a videotape, or presence of a relative during the examination could improve the tolerance to EGD. METHODS: Two hundred and twenty-six outpatients (pts), scheduled for a first-time non-emergency EGD were randomly assigned to 4 groups: Co-group (62 pts): throat anaesthesia only; Mi-group (52 pts): CS with i.v. midazolam; Regroup (58 pts): presence of a relative throughout the procedure; Vi-group (54 pts): additional information with a videotape. Anxiety was measured using the "Spielberger State and Trait Anxiety Scales". The patients assessed the overall discomfort during the procedure on an 100-mm visual analogue scale, and their tolerance to EGD answering a questionnaire. The endoscopist evaluated the technical difficulty of the examination and the tolerance of the patients on an 100-mm visual analogue scale and answering a questionnaire. RESULTS: Pre-endoscopy anxiety levels were higher in the Mi-group than in the other groups (P<0.001). On the basis of the patients' evaluation, EGD was well tolerated by 80.7% of patients in Mi-group, 43.5% in Co-group, 58.6% in Regroup, and 50% in Vi-group (P<0.01). The discomfort caused by EGD, evaluated by either the endoscopist or the patients, was lower in Mi-group than in the other groups. The discomfort was correlated with "age" (P<0.001) and "groups of patients" (P<0.05) in the patients' evaluation, and with "gender" (females tolerated better than males, P<0.001) and "groups of patients" (P<0.05) in the endoscopist's evaluation. CONCLUSION: Conscious sedation can improve the tolerance to EGD. Male gender and young age are predictive factors of bad tolerance to the procedure.
Factors affecting patient tolerance of unsedated upper gastrointestinal tract endoscopy
Nursing and Public Health
Background. Endoscopy of the upper gastrointestinal tract is a widely used diagnostic procedure. It can be a source of anxiety, discomfort and even pain for the patients. Objectives. The aim of the study was to assess the discomfort and anxiety associated with gastroscopy, examine their determinants and describe patients' preferences regarding medical procedures and personnel behavior. Material and methods. The study involved 50 patients (21 men and 29 women) who underwent an endoscopy of the upper gastrointestinal tract. The State-Trait Anxiety Inventory (STAI) was employed, as well as the authors' own two-part questionnaire, which was conducted before and after the endoscopy. Results. The average level of anxiety was 40.72 STAI points and the emetic reflex was its main source (52%). The average level of discomfort felt during the gastroscopy was 2.84 and was related to both age (p = 0.001), security and privacy during the examination (p = 0.03), as well as to the level of anxiety prior to examination (p = 0.05). The severity of the discomfort was not associated with gender, education or subjective assessment of knowledge about the examination. Half of the patients would have liked to be sedated. A majority of the respondents (61%) indicated that verbal reassurance is a desirable form of behavior of the medical staff. Conclusions. The main cause of patients' anxiety is fear of the discomfort associated with the emetic reflex. The discomfort experienced by patients during endoscopy is linked to their age group, with younger participants experiencing greater discomfort, higher levels of anxiety prior to the examination, and a lower sense of security and privacy. Patients value verbal reassurance, procedural information and behavioral instructions during the endoscopy. General sedation is preferred by patients.
Gastrointestinal Endoscopy, 2003
Background: Unsedated esophagoscopy with small-diameter endoscopes is generally well tolerated but of limited sensitivity for the diagnosis of esophageal mucosal disease. This study evaluated the sensitivity of esophagoscopy performed with new 4-mm diameter prototype batterypowered and video endoscopes. Patient tolerance for an unsedated examination with the 4-mm endoscopes was assessed and the performance characteristics of the battery-powered and video 4-mm endoscopes were compared. Methods: Patients referred for EGD were recruited to undergo an additional examination with a 4-mm endoscope. A prototype 60-cm long, 4-mm diameter battery-powered fiberoptic esophagoscope was used in the first 24 patients and a prototype 60-cm long, 4-mm diameter video esophagoscope in the next 27 patients. Examiners who were unaware of patient history and procedure indications recorded esophageal findings, ease of intubation, optical quality (5-point visual scale), and time for examination of the esophagus and then recorded esophageal findings after the standard EGD. Results: The sensitivity, specificity, and accuracy for identification of Barrett's esophagus was 100%; overall sensitivity, accuracy, and specificity for detecting esophageal lesions were, respectively, 91%, 98%, and 99%. Patient tolerance (assessed by symptom scores for choking, pain, and discomfort) and acceptability of unsedated esophagoscopy with the 4-mm diameter instruments were significantly better than in a historical group of patients examined with a 3-mm diameter endoscope. The optical quality of video endoscope was rated as superior to that of batterypowered endoscope, and esophageal examination was performed significantly quicker with the video versus the battery-powered endoscope (68 vs. 137 seconds; p = 0.001). Conclusions: Unsedated esophagoscopy with 4-mm diameter endoscopes may be an alternative to EGD for screening for Barrett's esophagus. Given the current state of endoscopic technology, a minimum diameter of 4 mm is required for satisfactory esophageal imaging. (Gastrointest Endosc 2003;57:300-4.) A Faulx, G Isenberg, et al.
Office-Based Ultrathin Esophagogastroduodenoscopy in a Primary Care Setting
The Journal of the American Board of Family Medicine, 2004
Background: Upper gastrointestinal complaints are common in primary care. These patients are often referred for evaluation with the use of esophagogastroduodenoscopy. This study examines the feasibility and safety of office-based ultrathin (diameter, 5.9 mm) esophagogastroduodenoscopy (u-EGD) without conscious sedation in a primary care setting.
Comparison of thin versus standard esophagogastroduodenoscopy
The Journal of family practice, 2002
To compare the tolerance, feasibility, and safety of ultrathin esophagogastroduodenoscopy (EGD) in unsedated patients with conventional EGD in sedated patients. This was an unblinded, randomized controlled trial. Diagnostic EGD was performed on 72 adult outpatients at a US Air Force community hospital residency. Patients were randomized to either ultrathin or conventional EGD (n = 33 and 39, respectively). Patients reported their tolerance of the procedure (pain, choking, gagging, and anxiety; scale 0-10), and the endoscopist reported the effectiveness of the procedure (successful intubation, reaching duodenum, retroflexion, and duration of examination and recovery) and safety (complications). No statistically significant difference was noted between the 2 groups in mean procedure time or pain during the procedure. Mean ( standard error) recovery time was approximately halved in the ultrathin group vs the conventional group (21.5 +/- 2.3 min vs 55.4 +/- 2.3 min, P < 0001). Althou...
Analytical Study of Upper Gastrointestinal Endoscopy-200 cases
2016
Background: Esophagogastroduodenoscopy (EGD) is an important tool to visualize the upper part of the gastrointestinal tract up to the duodenum. It has the added advantage of being not only a diagnostic but also a therapeutic tool. It’s importance in follow up cases is also well documented. It has indeed become a cost effective and reliable tool to modern surgery. Materials and methods: Clinically symptomatic cases of upper GI tract were made to undergo Upper GI Endoscopy after an informed written consent. The study covered 200 patients who were then analysed for different parameters. Our study showed that majority of patients were in their 3 rd decade with a male: female ratio of 2.03:1. Pain in abdomen was the main presenting complaint. Study showed that 62% of patients were smokers whereas 71% were non alcoholic. Gastritis was the prominent finding in 41 (20.5%) cases followed by Hiatus Hernia and Reflux Esophagitis in 19.5% and 13% respectively. The study was found to be normal i...