Upper gastrointestinal endoscopy without sedation: a prospective study of 2000 examination

Al-Atrakchi, Hisham A.

doi:10.1016/s0016-5107(89)72712-7

Cited by 92 publications

(32 citation statements)

References 9 publications

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“…Esophagogastroduodenoscopy (EGD) is a safe and quick procedure, and can be carried out without sedation [1] . However, it can evoke anxiety, feelings of vulnerability, embarrassment, and discomfort [2] .…”

Section: Introductionmentioning

confidence: 99%

Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice: A randomized trial

Trevisani

Cifalà²,

Sartori³

et al. 2007

WJG

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AIM: to compare the feasibility and patients' tolerance of esophagogastroduodenoscopy (EGD) using a thin endoscope with those of conventional oral EGD and to determine the optimal route of introduction of smallcaliber endoscopes. METHODS:One hundred and sixty outpatients referred for diagnostic EGD were randomly allocated to 3 groups: conventional (C)-EGD (9.8 mm in diameter), transnasal (TN)-EGD and transoral (TO)-EGD (5.9 mm in diameter). Pre-EGD anxiety was measured using a 100-mm visual analogue scale (VAS). After EGD, patients and endoscopists completed a questionnaire on the pain, nausea, choking, overall discomfort, and quality of the examination either using VAS or answering some questions. The duration of EGD was timed. Blood oxygen saturation (SaO2) and heart rate (HR) were monitored during EGD. RESULTS:Twenty-one patients refused to participate in the study. The 3 groups were well-matched for age, gender, experience with EGD, and anxiety. EGD was completed in 91.1% (41/45), 97.5% (40/41), and 96.2% (51/53) of cases in TN-EGD, TO-EGD, and C-EGD groups, respectively. TN-EGD lasted longer (3.11 ± 1.60 min) than TO-EGD (2.25 ± 1.45 min) and C-EGD (2.49 ± 1.64 min) (P < 0.05). The overall tolerance was higher (P < 0.05) and the overall discomfort was lower (P < 0.05) in TN-EGD group than in C-EGD group. EGD was tolerated "better than expected" in 73.2% of patients in TN-EGD group and 55% and 39.2% of patients in TO-EGD and C-EGD groups, respectively (P < 0.05). Endoscopy was tolerated "worst than expected" in 4.9% of patients in TN-EGD group and 17.5% and 23.5% of patients in TO-EGD and C-EGD groups, respectively (P < 0.05). TN-EGD caused mild epistaxis in one case. The ability to insufflate air, wash the lens, and suction of the thin endoscope were lower than those of conventional instrument (P < 0.001). All biopsies performed were adequate for histological assessment. CONCLUSION:Diagnostic TN-EGD is better tolerated than C-EGD. Narrow-diameter endoscope has a level of diagnostic accuracy comparable to that of conventional gastroscope, even though some technical characteristics of these instruments should be improved. Transnasal EGD with narrow-diameter endoscope should be proposed to all patients undergoing diagnostic EGD.

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Section: Introductionmentioning

confidence: 99%

Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice: A randomized trial

Trevisani

Cifalà²,

Sartori³

et al. 2007

WJG

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“…Although many clinical trials have documented the feasibility of endoscopies without any sedation [3, 4, 5], and reduction of cardiac stress under sedation does not seem to be a strong argument [6, 7], given the choice, a majority of patients would undoubtedly prefer sedation [8]. Patients’ opinions probably depend not solely on their own personal experiences: the (poor) reputation of endoscopic procedures and patients’ fears have become a consideration in public health viz.…”

Section: Introductionmentioning

confidence: 99%

The Dawning of a New Sedative: Propofol in Gastrointestinal Endoscopy

Heuss

Inauen²

2004

Digestion

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Background: Using gentler endoscopes and improved sedation, great strides have been made in enhancing patients’ comfort and acceptance of endoscopic procedures. Because morbidity and mortality have been associated with benzodiazepines in endoscopic sedation, safer alternatives were sought. Propofol (2,6-diisopropylphenol), a rapid and short-acting anesthetic, initially used in the 1980’s for general anesthesia induction and maintenance, is a promising candidate. Methods: This review article examines experiences and literature references of propofol’s use in endoscopic procedures. Three critical questions are posed: What are the major advantages and potential risks of propofol? When should propofol be used? Who should administer propofol, how should it be administered, and what type of monitoring is required? Results: With considerable inter-patient variability, the propofol dose must be carefully titrated according to the individual patient’s response. Factors influencing dosage include age, ASA class, patient’s height and procedure duration. Propofol’s primary risk is its narrow therapeutic range which necessitates careful patient monitoring. Conclusions: Propofol’s advantages over benzodiazepines and narcotics include a more rapid onset of action, full relief of discomfort and rapid recovery to alertness without residual sedative effects or anterograde amnesia, thereby making this drug a cost-effective and, with proper monitoring, safe choice.

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“…Music is not used routinely during endoscopic procedures. Some physicians start endoscopy without sedation [8, 9], particularly in non-anxious patients [10], however most prefer to perform endoscopic examinations with conscious sedation or under general anesthesia [11]. In the USA only one fifth of patients undergoing colonoscopy are willing to undergo the examination unsedated [12].…”

Section: Introductionmentioning

confidence: 99%

Perception of Gastrointestinal Endoscopy by Patients and Examiners with and without Background Music

Binek¹,

Sagmeister²,

Borovicka³

et al. 2003

Digestion

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Background/Aims: Several studies have reported improved patient comfort with music in the preoperative setting, however music has seldom been assessed during gastrointestinal endoscopy. We aimed to assess how background music may influence the perception of patients and examiners involved in endoscopic examinations. Methods: 301 patients (128 females, 173 males; mean age 59 years) were included in the study (EGD and colonoscopy) in a prospective fashion. 90 EGD and 61 colonoscopies were performed with music (50.17%) and 102 EGD and 48 colonoscopies without music (49.83%). Patients, nurses and endoscopists completed a questionnaire. Results: No significant differences in demographic data were found between the patients examined with or without music. Tolerance to the examination, pain sensation and perception of the endoscopy room ambiance were similar in both groups. The majority of patients (83.4%) expressed a preference for music during any future endoscopic examination and none perceived the music as disturbing. During the 151 examinations, music was considered unpleasant in 14 examinations by the physicians (9.3%) and in 11 examinations by the nurses (7.3%). Conclusions: Music has little influence on patients’ experience of gastrointestinal endoscopy. Nevertheless, the majority of patients felt music to be helpful and expressed a preference for music during any future examination. This positive attitude to music of patients is in contrast with the assessment of some endoscopists and nurses.

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Upper gastrointestinal endoscopy without sedation: a prospective study of 2000 examination

Cited by 92 publications

References 9 publications

Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice: A randomized trial

Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice: A randomized trial

The Dawning of a New Sedative: Propofol in Gastrointestinal Endoscopy

Perception of Gastrointestinal Endoscopy by Patients and Examiners with and without Background Music

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