Original Articles
Patient tolerance and acceptance of unsedated ultrathin esophagoscopy

Presented as a poster at the annual meeting of the American Society for Gastrointestinal Endoscopy, May 20-23, 2001, Atlanta, Georgia.
https://doi.org/10.1067/mge.2002.123274Get rights and content

Abstract

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). Conclusions: Patient acceptance of unsedated endoscopy even with an ultrathin instrument is limited. Anxiety assessment by the POMS-SF T/A can identify patients willing to undergo UUE. Patients who choose transoral UUE may be more willing to repeat the procedure. (Gastrointest Endosc 2002;55:620-3.)

Section snippets

Patients and methods

Outpatients referred for standard EGD from July to December 2000 were recruited for the study. Patients were excluded if they were unable to give consent. The protocol for the study was approved by the Institutional Review Board for Human Investigation at our institution. All patients in the study gave written informed consent for endoscopy as well as for participation in the research.

Results

A total of 98 patients (46 women, 52 men) were asked to participate in the study. Fifty-two patients (34 men and 18 women) were willing to participate. The mean age of the participants was 52 years (range, 20 to 84 years). Sixteen patients (33%) chose the transnasal approach and 36 (67%) the peroral approach for UUE. Ninety-five percent of the examinations with the ultrathin endoscope were completed. No complications were noted.

Discussion

The intravenous administration of sedative and analgesic drugs for EGD is routine in the United States and Western Europe. Adverse outcomes and fatalities have been reported, respectively, in 0.54% and 0.03% of patients undergoing EGD, and up to 50% to 60% of these are related to the use of conscious sedation.3, 9, 10 Conscious sedation is believed to improve patient tolerance and acceptance of endoscopy. However, it has significant disadvantages including the need for close monitoring during

Cited by (0)

Reprint requests: Amitabh Chak, MD, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106-1736.

View full text