Modified mallampati classification as a clinical predictor of peroral esophagogastroduodenoscopy tolerance

Abstract

BackgroundUnsedated esophagogastroduodenoscopy (EGD) is simpler and safer than sedated EGD; however, approximately 40% of patients cannot tolerate it. Early identification of patients likely to poorly tolerate unsedated EGD is valuable for improving compliance. The modified Mallampati classification (MMC) has been used to evaluate difficult tracheal intubation and laryngoscope insertion. We tried to assess the efficacy of MMC to predict the tolerance of EGD in unsedated patients.MethodsTwo hundred patients who underwent an unsedated diagnostic EGD were recruited. They were stratified according to the view of the oropharynx as either MMC class I + II (good view) or class III + IV (poor view). EGD tolerance was assessed in three ways: gag reflex by endoscopist assessment, patient satisfaction by interview, and the degree of change in vital signs.ResultsMMC was significantly correlated to gag reflex (P < 0.001), patient satisfaction (P = 0.028), and a change of vital signs (P = 0.024). Patients in the poor view group had a 3.87-fold increased risk of gag reflex (P < 0.001), a 1.78-fold increased risk of unsatisfaction (P = 0.067), and a 1.96-fold increased risk of a change in vital signs (P = 0.025) compared to those in the good view group.ConclusionsMMC appears to be a clinically useful predictor of EGD tolerance. Patients with poor view of oropharynx by MMC criteria may be candidates for sedated or transnasal EGD.

Serbian Translation and Cross-Cultural Validation of the Questionnaire for Assessing Patient Satisfaction with Endoscopic Examination of the Digestive Tract

“…A study by Campo R et al indicated that having prior endoscopy can significantly affect the tolerance of examinations (5). Two studies conducted in Taiwan, which included respondents who had an upper endoscopy without sedation, found associations between negative experience with prior endoscopies and increased anxiety before the endoscopic examination as well as patient satisfaction (12,16). Similar results were obtained from a study conducted in Germany on patients who were included in the screening programme for colorectal cancer, where researchers tried to establish a link between the avoidance of examinations and previous bad experiences (18).…”

“…The use of conscious sedation varies from country to country, continent to continent, and even in different endoscopy centres within the same country. The use of conscious sedation is associated with higher costs, an extension of the duration of the procedure, the need for the monitoring of vital functions and an increasing incidence of complications (10,12,14,16,18).…”

“…The modified GHAA-9 questionnaire was recommended by the American Society for Gastrointestinal Endoscopy for the assessment of satisfaction and did not include all the necessary factors for evaluation of patient satisfaction (3,7,19). Some other instruments are mainly used to examine factors affecting the toleration of the examination (2)(3)(4)12,14,16,17,20). In the Serbian language, there is no validated questionnaire for the assessment of patient satisfaction with the endoscopic examination of the digestive tract.…”

“…Previous studies have indicated that approximately 5% of patients refused a proposed endoscopic examination, and an additional 10% required persuasion to undergo the examination. While some studies indicate that nearly 40% of these patients have difficulty tolerating examinations, approximately 10% of patients experience severe discomfort during the examination (5,12,13). The most common reasons for refusal of these procedures are the fear of pain and a feeling of shame.…”

The Clinical Evaluation and Use of Sleep Studies in Neurological Practice

“…A comprehensive physical exam with special attention to neck size (>16 cm in women, >17 cm in men) [13], nasal airflow (obtained by the patient occluding one nostril at a time), nasal septal deviation, jaw positioning (retrognathia), tonsil hypertrophy, narrow or high-arched hard palate, and Mallampati score (III or IV) (Fig. 1) [11,14].…”