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Aya I, Ichijima R, Sugita T, Nakayama M, Takasu A, Ogura K, Gotoda T, Kogure H. A single-center prospective study on pain alleviation during peroral upper endoscopy with an ultrathin endoscope. BMC Gastroenterol 2023; 23:325. [PMID: 37735366 PMCID: PMC10514927 DOI: 10.1186/s12876-023-02965-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/20/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The efficacy of transnasal endoscopy using an ultrathin endoscope has been reported in several studies. However, few studies regarding peroral endoscopy with ultrathin endoscopes with high resolution have been reported. This study investigates the pain alleviation of peroral endoscopy with an ultrathin endoscope. METHODS Patients with a history of peroral endoscopy using a conventional, normal-diameter scope with no sedation who underwent peroral esophagogastroduodenoscopy (EGD) using a thin scope between April-July 2022 were included in this study. After the procedure, the patients completed a questionnaire evaluating pain during the examination and willingness to repeat the procedure. The physicians were surveyed regarding their level of satisfaction. The primary endpoint was patient satisfaction, which corresponded to the rate of patients who rated the thin endoscope as more comfortable or somewhat more comfortable than the previously-used, conventional endoscope. RESULTS One hundred and forty-five patients were included in the analyses. Patient satisfaction was achieved in 86.2% (125/145) of patients. The median visual analog scale pain score was 3 (0-7) points in this study, which is significantly lower than the pain score after the previous endoscopy (5 (0-10) points; p < 0.001). In addition, 96% (24/25) of patients who underwent EGD by an expert and 95.8% (115/120) who underwent EGD by a non-expert were willing to repeat endoscopy using the thin scope (p = 0.69). CONCLUSION Peroral endoscopy using a thin scope reduces patient pain regardless of the endoscopist's experience.
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Affiliation(s)
- Iwao Aya
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
- Health Management Center, Toranomon Hospital, Tokyo, Japan
| | - Ryoji Ichijima
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Tomomi Sugita
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masako Nakayama
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ayaka Takasu
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kanako Ogura
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hirofumi Kogure
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
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Chang CF, Huang TY, Huang HH, Shih YL, Chang WK, Hsieh TY, Wu LS, Chen KW, Lin HH. Impact of endoscopic sedation on gastric polyp detection: A one-center retrospective observational study. Medicine (Baltimore) 2020; 99:e22556. [PMID: 33031301 PMCID: PMC10545299 DOI: 10.1097/md.0000000000022556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 05/03/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022] Open
Abstract
Sedation esophagogastroduodenoscopy (EGD) has become more prevalent in many countries. However, owing to the limitation of health insurance payment for sedation EGD in Taiwan, non-sedation EGD still accounts for the majority of cases. This study was aimed to explore the differences between the sedation and non-sedation groups in terms of endoscopic findings, such as detection rate of gastric polyp of any size, number of detected gastric polyps, and location of the gastric polyps detected.We enrolled 10,940 patients who underwent EGD between January 1, 2016 and December 31, 2016 at the Tri-Service General Hospital; among the patients, 1900 received intravenous sedation (IVS) and 9040 did not. The data reviewed included demographics, parameters of the polyp (number, size, and location), and pathology.Compared with the non-sedation group, the sedation group had a higher overall polyp detection rate (P < .001); a greater number of detected polyps (Odds ratio 1.50, P = .007); and a higher detection rate of smaller polyps, such as fundic gland polyp, and hyperplastic polyp (P < .001). Among the pathological findings, gastric neuroendocrine tumor (NET) was detected using EGD in 2 cases and manifested as small polyps (<0.05 cm), and it showed significantly better detection rates in the sedation EGD group than in the non-sedation EGD group (P = .002).Sedation EGD could enhance a patients willingness and cooperation during EGD. Furthermore, sedation EGD increased the detection rates of small gastric polyps and was more likely to enable identification of unusual findings, such as gastric NET.
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Affiliation(s)
- Chao-Feng Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Lian-Shan Wu
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien County, Taiwan
| | - Kai-Wen Chen
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien County, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
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Nagaya T, Miyahara R, Funasaka K, Furukawa K, Yamamura T, Ishikawa T, Ohno E, Nakamura M, Kawashima H, Nakashima T, Nakata S, Hirooka Y. Nasal patency as a factor for successful transnasal endoscopy. Nagoya J Med Sci 2020; 81:587-595. [PMID: 31849376 PMCID: PMC6892663 DOI: 10.18999/nagjms.81.4.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In recent years, transnasal endoscopy had been more widely accepted for its safety and convenience, and although it can lead to a weaker pharyngeal reflex, compared with the effects of transoral endoscopy, examinees often suffer intolerable pain and discomfort during passage of the endoscope through the nasal cavity. The aim of this study was to estimate the relationship between the uncomfortable factors during transnasal endoscopy and nasal patency. The subjects comprised 23 consecutive patients who underwent transnasal endoscopy from October 2007 to April 2009 at our Gastroenterology and Otorhinolaryngology Departments. Immediately prior to endoscopy, the left and right nasal resistance was measured with an active anterior rhinomanometer; a value of 100 Pa was determined as nasal resistance. The transnasal endoscope was inserted in the subjectively preferred side by the examinee. Thereafter, the subjects were asked to fill in a questionnaire on physical tolerance during the procedure, to quantify the sensations of nasal pain, nausea, and choking on a 10-point visual analogue scale. The mean scores were 3.0 ± 2.7 for nasal pain, 1.7 ± 2.0 for choking, and 1.6 ± 1.9 for nausea. The most intolerable factor among the complaints was pain (45%), which was followed by nausea (18%) and choking (9%). Unilateral nasal resistance was significantly related with nasal pain only (P = 0.0135). In conclusion, the most difficult problem during transnasal endoscopy was pain, which was related to nasal patency. We successfully demonstrated the clinical significance of nasal patency in determining the side of insertion for transnasal endoscopy.
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Affiliation(s)
- Toshihiko Nagaya
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Internal Medicine, Tohno Kosei Hospital, Mizunami, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Funasaka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsutomu Nakashima
- Ichinomiya Medical Treatment & Habilitation Center, Ichinomiya, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
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Wahba G, Neshkova E, Vuille-Lessard É, Bouin M. Is topical lidocaine beneficial before catheter insertion in esophageal manometry and ambulatory pH monitoring? Neurogastroenterol Motil 2019; 31:e13687. [PMID: 31321837 DOI: 10.1111/nmo.13687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/06/2019] [Accepted: 07/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Conventionally, topical anesthesia is applied to improve the tolerance of esophageal manometry (EM) and ambulatory pH monitoring (apH) but there is presently no evidence supporting this practice. We aimed to compare the tolerance of EM and apH with vs without topical lidocaine anesthesia. METHODS A prospective study was conducted at our center between January 2017 and January 2019. All patients who underwent EM or apH and completed a systematically distributed standardized patient survey were included. From January 2017 to June 2018, all patients had a viscous lidocaine solution applied before EM and apH ("lidocaine" group). After June 2018, we ceased applying any topical anesthesia ("no lidocaine" group). Patient-reported adverse effects and satisfaction scores were compared between these two patient groups. KEY RESULTS Two hundred forty-nine patient surveys were included. "Lidocaine" (n = 124) and "no lidocaine" (n = 125) groups were similar in age (56.9 ± 14.0 vs 56.0 ± 13.7; P = .77) and gender distributions (65.9% vs 63.3% female; P = .68). Patients in the "lidocaine" group were less likely to report pain during catheter insertion (33.6% vs 50.8%; P = .007, OR: 0.49 [95% CI 0.29-0.83]) and reported a lower overall pain score (2.82 ± 1.38 vs 3.20 ± 1.42 on 5; P = .04). There was a tendency toward increased global satisfaction with lidocaine application but that was not statistically significant (4.36 ± 1.05 vs 4.11 ± 1.13; P = .08). In subgroup analyses, female patients, younger patients, and patients who underwent EM were more likely to benefit from lidocaine application. CONCLUSIONS AND INFERENCES Application of topical lidocaine before esophageal motility tests reduces pain during catheter insertion and overall pain.
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Affiliation(s)
- George Wahba
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | | | | | - Mickael Bouin
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
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Wickremeratne T, Turner S, O'Beirne J. Systematic review with meta-analysis: ultra-thin gastroscopy compared to conventional gastroscopy for the diagnosis of oesophageal varices in people with cirrhosis. Aliment Pharmacol Ther 2019; 49:1464-1473. [PMID: 31059160 DOI: 10.1111/apt.15282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/06/2018] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Haemorrhage from ruptured oesophageal varices is a common cause of death in people with cirrhosis. Guidelines recommend screening for varices at time of cirrhosis diagnosis and throughout the course of the disease. Conventional gastroscopy is the criterion standard for variceal screening; however, is invasive, costly, and carries risks related to use of sedation. Ultra-thin gastroscopy (using endoscopes with a shaft diameter ≤6 mm) has been proposed as an alternative method of variceal screening that mitigates these risks. AIM To determine the diagnostic accuracy of ultra-thin gastroscopy compared to conventional gastroscopy for the diagnosis of varices in people with cirrhosis. METHODS MEDLINE, EMBASE and Cochrane library databases were searched for studies that evaluated the accuracy of ultra-thin gastroscopy compared to conventional gastroscopy in the diagnosis of oesophageal varices. RESULTS Ten studies, 7 in known cirrhosis, with 752 participants were included in this systematic review. The overall prevalence of oesophageal varices was 42%. On bivariate modelling, pooled estimates of sensitivity and specificity were 98% (95% CI 93%-99%) and 96% (95% CI 91%-99%) respectively. The positive and negative likelihood ratios were 28 (95% CI 10.7-73.2) and 0.02 (95% CI 0.01-0.72) respectively. Kappa coefficient for inter-observer agreement for any varices ranged from 0.45 to 0.90. No serious adverse events related to ultra-thin gastroscopy were reported. CONCLUSIONS Ultra-thin gastroscopy is accurate in the diagnosis of oesophageal varices, safe and well tolerated. It is a valid alternative to conventional gastroscopy for the screening and surveillance of varices in people with cirrhosis.
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Affiliation(s)
- Tehara Wickremeratne
- Gastroenterology and Hepatology, Sunshine Coast University Hospital, Birtinya, Qld, Australia
| | - Stephanie Turner
- Gastroenterology and Hepatology, Sunshine Coast University Hospital, Birtinya, Qld, Australia
| | - James O'Beirne
- Gastroenterology and Hepatology, Sunshine Coast University Hospital, Birtinya, Qld, Australia.,Hepatology, University of the Sunshine Coast, Sippy downs, Qld, Australia
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Schuldt AL, Kirsten H, Tuennemann J, Heindl M, van Bommel F, Feisthammel J, Hollenbach M, Hoffmeister A. Necessity of transnasal gastroscopy in routine diagnostics: a patient-centred requirement analysis. BMJ Open Gastroenterol 2019; 6:e000264. [PMID: 31139423 PMCID: PMC6506089 DOI: 10.1136/bmjgast-2018-000264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/10/2019] [Accepted: 02/22/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction Numerous indications require regular upper gastrointestinal endoscopy (oesophagogastroduodenoscopy; EGD) in outpatients. In most cases, peroral gastroscopy is performed. The aim of this study was to evaluate the need of transnasal gastroscopy (nEGD) in outpatients. Methods A questionnaire was used to assess patients’ preferred choice of method, previous experience with EGD, psychological aspects and sociodemographic data. Furthermore, patient satisfaction with and potentially perceived discomfort during the examination as well as preference for a method in regard to future examinations was evaluated. Results From September 2016 to March 2017, a total of 283 outpatients at endoscopy of the University Hospital of Leipzig were approached to participate in the study. 196 patients were eligible, of whom 116 (60%) chose nEGD. For 87 patients (87/283, 31%) nEGD had to be excluded for medical reasons. The average age in the total sample was 53 (±17) years. 147 (77%) have had previous experience with peroral EGD (oEGD). Of the nEGD examined patients 83% were fairly up to extremely satisfied with the procedure. Satisfaction significantly predicted the choice of future EGD examinations. Nasal pain experienced during nEGDs was associated with rejection of nEGD in further EGD examinations (p<0.01). Patients who did choose a specific procedure were more likely to select the same procedure as their future preference (χ²= 73.6, df=1, p<0.001); this preference was unaffected by the procedure that had been chosen previously (reselecting nEGD: 84%, oEGD: 89%, p=0.874). Conclusion nEGD without sedation is a viable alternative. Patient satisfaction with nEGD is high, and reselection rate for nEGD is similar to that for oEGD. As a result of this study nEGD is now offered as a routine procedure at the University of Leipzig. Trial registration number NCT03663491.
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Affiliation(s)
- Anna-Livia Schuldt
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig, Germany
| | - Jan Tuennemann
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Mario Heindl
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Florian van Bommel
- Klinik für Gastroenterologie und Rheumatologie, University Hospital Leipzig, Leipzig, Germany
| | - Juergen Feisthammel
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
| | - Marcus Hollenbach
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
| | - Albrecht Hoffmeister
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
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McCulloch A, Roy O, Massey D, Hedges R, Skerratt S, Wilson N, Woodward J. Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates. Frontline Gastroenterol 2018; 9:105-109. [PMID: 29588837 PMCID: PMC5868436 DOI: 10.1136/flgastro-2017-100894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/18/2017] [Accepted: 11/19/2017] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Percutaneous endoscopic gastrostomy (PEG) tube placement is associated with a high risk of cardiorespiratory complications in patients with significant respiratory compromise. This study reports a case series of high-risk patients undergoing PEG placement using a modified technique-nasal unsedated seated PEG (nuPEG) placement. DESIGN Retrospective review of 67 patients at high risk of complications undergoing PEG placement between September 2012 and December 2016. SETTING UK specialist tertiary centre for clinical nutrition support. INTERVENTIONS Patients underwent 'push' PEG placement using nasal endoscopy without sedation in a seated position. MAIN OUTCOME MEASURES Procedural success and tolerability, short term (within 24 hours), medium term (24 hours to 30 days) complications and survival were recorded. RESULTS 67 patients underwent 68 nuPEG placements. The majority had motor neuron disease (46/67). One patient developed a lower respiratory tract infection the following day. Two patients experienced accidental displacement of their PEG within 2 weeks. One patient died within 30 days of nuPEG insertion due to reasons unrelated to the procedure. Endoscopic comfort scores of 1 or 2 (98.0%) indicated good tolerance. A failure rate of 10.5% was attributed to intrathoracic displacement of the stomach, almost certainly due to the advanced stage of the neurological disease and associated diaphragmatic weakness. CONCLUSIONS Our experience with the nuPEG technique suggests that it is safe and well tolerated in high-risk patients. As a result, it has now entirely supplanted radiologically inserted gastrostomy insertion in our institution and we recommend it as the method of choice for gastrostomy tube insertion in such patients.
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Affiliation(s)
- Adam McCulloch
- Cambridge Intestinal Failure and Transplant, Addenbrooke’s Hospital, Cambridge, UK
| | - Ovishek Roy
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Dunecan Massey
- Cambridge Intestinal Failure and Transplant, Addenbrooke’s Hospital, Cambridge, UK
| | - Rachel Hedges
- Cambridge Intestinal Failure and Transplant, Addenbrooke’s Hospital, Cambridge, UK
| | - Serena Skerratt
- Cambridge Intestinal Failure and Transplant, Addenbrooke’s Hospital, Cambridge, UK
| | - Nicola Wilson
- Cambridge Intestinal Failure and Transplant, Addenbrooke’s Hospital, Cambridge, UK
| | - Jeremy Woodward
- Cambridge Intestinal Failure and Transplant, Addenbrooke’s Hospital, Cambridge, UK
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Parker C, Alexandridis E, Plevris J, O'Hara J, Panter S. Transnasal endoscopy: no gagging no panic! Frontline Gastroenterol 2016; 7:246-256. [PMID: 28839865 PMCID: PMC5369487 DOI: 10.1136/flgastro-2015-100589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Transnasal endoscopy (TNE) is performed with an ultrathin scope via the nasal passages and is increasingly used. This review covers the technical characteristics, tolerability, safety and acceptability of TNE and also diagnostic accuracy, use as a screening tool and therapeutic applications. It includes practical advice from an ear, nose, throat (ENT) specialist to optimise TNE practice, identify ENT pathology and manage complications. METHODS A Medline search was performed using the terms "transnasal", "ultrathin", "small calibre", "endoscopy", "EGD" to identify relevant literature. RESULTS There is increasing evidence that TNE is better tolerated than standard endoscopy as measured using visual analogue scales, and the main area of discomfort is nasal during insertion of the TN endoscope, which seems remediable with adequate topical anaesthesia. The diagnostic yield has been found to be similar for detection of Barrett's oesophagus, gastric cancer and GORD-associated diseases. There are some potential issues regarding the accuracy of TNE in detecting small early gastric malignant lesions, especially those in the proximal stomach. TNE is feasible and safe in a primary care population and is ideal for screening for upper gastrointestinal pathology. It has an advantage as a diagnostic tool in the elderly and those with multiple comorbidities due to fewer adverse effects on the cardiovascular system. It has significant advantages for therapeutic procedures, especially negotiating upper oesophageal strictures and insertion of nasoenteric feeding tubes. CONCLUSIONS TNE is well tolerated and a valuable diagnostic tool. Further evidence is required to establish its accuracy for the diagnosis of early and small gastric malignancies. There is an emerging role for TNE in therapeutic endoscopy, which needs further study.
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Affiliation(s)
- Clare Parker
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK
| | | | - John Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - James O'Hara
- Department of Otolaryngology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon Panter
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, Newcastle upon Tyne, UK
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Abstract
Although conventional esophagogastroduodenoscopy has become widespread in its applications and availability, it is constrained by the requirement for patient sedation. This requirement contributes to morbidity, time lost from work, and additional resource utilization in personnel and facilities. Small-caliber endoscopy is an emerging technology that enables transnasal evaluation of the upper gastrointestinal tract in a unsedated patient. This procedure can be performed in a wider range of settings, including the clinic setting where a dedicated conscious sedation suite is not available and can be incorporated into the office visit. The applications of small-caliber endoscopy include general diagnostic upper endoscopy, screening and surveillance of Barrett esophagus, and intraoperative diagnostics or postoperative evaluation of the upper gastrointestinal tract. Therapeutic applications include the placement of nasoduodenal feeding tubes, esophageal pH catheters, and impedance catheters. When used in the sedated patient, small-caliber endoscopy can also facilitate esophageal stricture dilation and transnasal placement of a percutaneous endoscopic gastrostomy tube. This review discusses the techniques, equipment, and applications of small-caliber endoscopy of the upper gastrointestinal tract.
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Affiliation(s)
- Charles Y Kim
- Department of Surgery, Oregon Health and Science University, Portland Veteran's Administration Medical Center, Portland, Oregon 97207, USA
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Friedlander JA, DeBoer EM, Soden JS, Furuta GT, Menard-Katcher CD, Atkins D, Fleischer DM, Kramer RE, Deterding RR, Capocelli KE, Prager JD. Unsedated transnasal esophagoscopy for monitoring therapy in pediatric eosinophilic esophagitis. Gastrointest Endosc 2016; 83:299-306.e1. [PMID: 26142551 PMCID: PMC4698253 DOI: 10.1016/j.gie.2015.05.044] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/25/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Unsedated transnasal endoscopy (TNE) is safer and less costly than sedated EGD. The aim of this study was to evaluate the performance of TNE with biopsies in monitoring the esophageal mucosa of pediatric patients with eosinophilic esophagitis. METHODS Patients between 8 and 17 years of age with eosinophilic esophagitis and their parents were enrolled. Unsedated TNE was performed. A 2.8-mm (1.2-mm channel) or a 4-mm flexible bronchoscope (2-mm channel) was used, and esophageal biopsy specimens were obtained. Biopsy specimen analysis, duration, adverse events, and billing charges of TNE were assessed. Immediately after TNE and a minimum of 2 weeks later, a modified Group Health Association of America 9 survey and a preference questionnaire were completed, respectively. RESULTS Twenty-one of 22 enrolled patients underwent TNE. TNE was performed with no serious adverse events. Histopathological analysis revealed 0 eosinophils per high-power field (n = 12), fewer than 15 eosinophils per high-power field (n = 4), and more than 15 eosinophils per high-power field (n = 5). The total epithelial surface area of mucosal biopsy samples from either TNE Forceps (1.2 mm or 2 mm biopsy channel forceps) compared with those obtained during the subject's previous EGD by using standard endoscopic forceps was not statistically different (P = .308 [1.2 mm]/P = .492 [2 mm]). All parents and 76.2% of subjects would undergo the TNE again. TNE was preferred over EGD by 85.7% of parents and 52.4% of subjects. The modified Group Health Association of America 9 survey revealed a high degree of satisfaction (average, 43.19 ± 2.6; maximum score, 45). Charges associated with TNE were 60.1% lower than for previous EGDs. CONCLUSIONS Unsedated TNE is an effective, lower-cost procedure for monitoring the esophageal mucosa of children with eosinophilic esophagitis.
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Affiliation(s)
- Joel A. Friedlander
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
- Aerodigestive Program, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Emily M. DeBoer
- Aerodigestive Program, Children’s Hospital Colorado, Aurora, Colorado, USA
- Breathing Institute, Children’s Hospital Colorado, Section of Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jason S. Soden
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
- Aerodigestive Program, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Glenn T. Furuta
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
- Gastrointestinal Eosinophilic Diseases Program, Children’s Hospital of Colorado, Aurora, Colorado, USA
| | - Calies D. Menard-Katcher
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
- Gastrointestinal Eosinophilic Diseases Program, Children’s Hospital of Colorado, Aurora, Colorado, USA
| | - Dan Atkins
- Gastrointestinal Eosinophilic Diseases Program, Children’s Hospital of Colorado, Aurora, Colorado, USA
- Allergy Section, Children’s Hospital Colorado, Section of Allergy, Immunology, and Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David M. Fleischer
- Gastrointestinal Eosinophilic Diseases Program, Children’s Hospital of Colorado, Aurora, Colorado, USA
- Allergy Section, Children’s Hospital Colorado, Section of Allergy, Immunology, and Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert E. Kramer
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robin R. Deterding
- Aerodigestive Program, Children’s Hospital Colorado, Aurora, Colorado, USA
- Breathing Institute, Children’s Hospital Colorado, Section of Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kelley E. Capocelli
- Division of Pediatric Pathology, Children’s Hospital of Colorado, Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeremy D. Prager
- Aerodigestive Program, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Otolaryngology, Children’s Hospital Colorado, Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Sami SS, Subramanian V, Ortiz-Fernández-Sordo J, Saeed A, Singh S, Guha IN, Iyer PG, Ragunath K. Performance characteristics of unsedated ultrathin video endoscopy in the assessment of the upper GI tract: systematic review and meta-analysis. Gastrointest Endosc 2015; 82:782-92. [PMID: 26371850 DOI: 10.1016/j.gie.2015.07.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/07/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Reports on the performance of unsedated ultrathin endoscopy via the transnasal (uTNE) and transoral (uTOE) routes are conflicting. We aimed to estimate the technical success rate, patient preference, and acceptability of uTNE and uTOE alone and in comparison with conventional EGD (cEGD; with or without sedation). METHODS A systematic review and meta-analysis was performed on all primary studies reporting the outcomes of interest. Electronic databases (Cochrane library, MEDLINE, EMBASE) were searched on February 1, 2014. RESULTS Thirty-four studies met the inclusion criteria with 6659 patients in total. The pooled technical success rate was 94.0% for uTNE (95% confidence interval [CI], 91.6-95.8; 30 studies) and 97.8% for uTOE (95% CI, 95.6-98.9; 16 studies). The difference in proportion of success for uTNE compared with cEGD was -2.0% (95% CI, -4.0 to -1.0; 18 studies), but that difference was not significant when uTNE < 5.9 mm in diameter was used (-1.0%; 95% CI, -3.0 to .0; 9 studies). There was no significant difference in success rate between uTOE and cEGD (.0%; 95% CI, -1.0 to 2.0; 10 studies). The pooled difference in proportion of patients who preferred uTNE over cEGD was 63.0% (95% CI, 49.0-76.0; 10 studies), whereas preference for uTOE versus cEGD was not significantly different (38.0%; 95% CI, -4.0 to 80.0; 2 studies). Acceptability was high for both uTNE (85.2%; 95% CI, 79.1-89.9; 16 studies) and uTOE (88.7%; 95% CI, 82.4-92.9; 10 studies). CONCLUSIONS Technical success rate for uTNE < 5.9 mm is equivalent to cEGD. uTNE has high patient acceptability, with better patient preference, and therefore could be a useful alternative to cEGD for screening purposes. uTOE had a similar technical success rate but an equivocal preference to cEGD.
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Affiliation(s)
- Sarmed S Sami
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Venkataraman Subramanian
- Molecular Gastroenterology, Institute of Biomedical and Clinical Sciences, University of Leeds, and Center for Digestive Diseases, St James University Hospital, Leeds, UK
| | - Jacobo Ortiz-Fernández-Sordo
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Alhussain Saeed
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Indra N Guha
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Prasad G Iyer
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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Alexandridis E, Inglis S, McAvoy NC, Falconer E, Graham C, Hayes PC, Plevris JN. Randomised clinical study: comparison of acceptability, patient tolerance, cardiac stress and endoscopic views in transnasal and transoral endoscopy under local anaesthetic. Aliment Pharmacol Ther 2014; 40:467-76. [PMID: 25039412 DOI: 10.1111/apt.12866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 06/10/2014] [Accepted: 06/19/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Transnasal endoscopy (TNE) with ultrathin endoscopes has been advocated as an attractive alternative, for diagnostic upper endoscopy. AIM To assess tolerability, acceptability and quality of TNE, in comparison with standard upper endoscopy (SOGD, standard oesophago-gastro-duodenoscopy) under local anaesthetic. METHODS We prospectively recruited 157 patients (83 females/74 males) mean age 57 years. The Fujinon EG530N (5.9 mm) and EG530WR (9.4 mm) endoscopes were used. The endoscopist and all patients completed detailed questionnaires regarding tolerability, acceptance and quality of endoscopy using standard visual analogue scales (VAS). Oxygen saturation (SaO2 ), heart rate (HR) and systolic blood pressure (SBP) were recorded. Quality of biopsies was evaluated. RESULTS Analysis included 161 procedures (TNE:79, SOGD:82) with duodenal intubation achieved in all patients. VAS scores for patient comfort were significantly better in the TNE group (7.3 vs. 5.3 respectively, P < 0.001). Twenty patients with previous experience of standard endoscopy were randomised to TNE and 19 of them (95.5%) preferred the TNE. Gagging was significantly less in the TNE group (0.12 vs. 3.41 respectively, P < 0.001). Cardiovascular stress was significantly less in the TNE group irrespective of the degree of gagging or comfort. TNE biopsies were smaller, but adequate for definitive diagnosis, similarly to standard endoscopy. CONCLUSIONS Transnasal endoscopy is superior to SOGD in terms of comfort and patient acceptance with significantly less cardiovascular stress. TNE can routinely be used as alternative to SOGD under local anaesthetic, for diagnosis and should be preferentially offered in cardiorespiratory compromised patients.
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Affiliation(s)
- E Alexandridis
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
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Lee YS, Bang CS, Suk KT, Lee YH, Ham YL, Sung H, Ko JS, Kim WW, Kim JH, Kim HS, Park HJ, Kim MS. Catheter-free method is sufficient for preparation for transnasal endoscopy: randomized controlled trial. Dig Endosc 2014; 26:385-91. [PMID: 24283587 DOI: 10.1111/den.12209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/23/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Although transnasal endoscopy (TNE) is generally a comfortable and safe procedure, it has some disadvantages, such as complicated preprocessing and occasional repulsion reaction during catheterization. In an attempt to simplify the preprocessing method, the efficacy of a catheter-free method in which a catheter is not inserted into the nasal cavity was assessed. METHODS The present study was a prospective, open-label, single-center, randomized controlled study with parallel assignment allocation 1:1. Between March 2009 and August 2009, a total of 93 TNE-naïve patients were enrolled and randomized. Patients were prospectively randomized into two groups (catheter-free vs catheter-insertion method). Patients who prepared according to the catheter-free method and who were unsuccessful underwent the catheter-insertion method. Clinical characteristics, success rate, complications, vital signs, acceptability, and tolerability were assessed and compared. RESULTS Success rates of the catheter-free and catheter-insertion methods were 88% (n=44) and 88% (n=38) (P>0.05), respectively. Causes of failure in the catheter-free method included severe rhinalgia (n=1, 2%) and narrowing of the nasal cavity (n=5, 10%). Causes of failure in the catheter-insertion method included narrowing of the nasal cavity (n=5, 11%). Six patients whose TNE failed with the catheter-free method also experienced failed TNE with the catheter-insertion method. There were no statistical differences in vital signs, acceptability, and tolerability. CONCLUSION The catheter-free method is sufficient for preparation for TNE. The success rate of TNE depends more on the structure of the nasal cavity than the preprocessing method.
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Affiliation(s)
- Yong Sub Lee
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
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Rivory J, Lépilliez V, Gincul R, Guillaud O, Vallin M, Bouffard Y, Sagnard P, Ponchon T, Dumortier J. "First look" unsedated transnasal esogastroduodenoscopy in patients with upper gastrointestinal bleeding? A prospective evaluation. Clin Res Hepatol Gastroenterol 2014; 38:209-18. [PMID: 24268304 DOI: 10.1016/j.clinre.2013.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/04/2013] [Accepted: 10/10/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS With small diameter endoscopes, transnasal esophagogastroduodenoscopy (t-EGD) is routinely performed. The aim of this prospective observational study was to evaluate the role of t-EGD for upper gastrointestinal bleeding (UGIB). PATIENTS AND METHODS One hundred and forty-five consecutive patients (mean age, 66±18.4 years) with suspicion of UGIB were classified a priori into 3 groups according to initial clinical presentation: (1) intensive care unit with EGD under sedation, (2) endoscopy unit with EGD under transient sedation and (3) unsedated t-EGD as "first look". Demographic, clinical and biological parameters, Rockall and Blatchford scores, endoscopic diagnosis and treatment, and outcome were analysed. RESULTS Unsedated t-EGD was attempted in 89 patients, performed in 52 (5 failures, 28 contraindications) and the procedure was converted under sedation for 2 patients. Based on ASA classification, clinical (blood pressure, hemodynamical failure) and biological variables (hemoglobin, platelets, creatinine), these patients were less severe than in the other groups. Pre-endoscopic Rockall and Blatchford scores were significantly lower in this group. More patients in this group presented significant cardiovascular co-morbidity (47.2%), taking aspirin, clopidogrel and/or anticoagulant. CONCLUSIONS Our results strongly support that "first look" unsedated t-EGD can avoid unnecessary sedation in selected patients with UGIB, presenting a low probability for endoscopic haemostatic treatment and high sedation risks.
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Affiliation(s)
- Jérôme Rivory
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France
| | - Vincent Lépilliez
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France
| | - Rodica Gincul
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France
| | - Olivier Guillaud
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France
| | - Mélanie Vallin
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France
| | - Yves Bouffard
- Hospices civils de Lyon, hôpital Edouard-Herriot, département d'anesthésie-réanimation, Lyon, France
| | - Pierre Sagnard
- Hospices civils de Lyon, hôpital Edouard-Herriot, département d'anesthésie-réanimation, Lyon, France
| | - Thierry Ponchon
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France
| | - Jérôme Dumortier
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France.
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Kawai T, Sugimoto H, Fukuzawa M, Fukuzawa M, Kusano C, Gotoda T, Moriyasu F. Upper gastrointestinal complications induced by anti-platelet agents. Clin J Gastroenterol 2013; 6:264-268. [DOI: 10.1007/s12328-013-0409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 06/23/2013] [Indexed: 11/26/2022]
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Kim JI, Kim JS, Kim BW, Song JY, Ham JH, Lee BI, Choi HJ, Ji JS, Choi H. Ultrathin endoscope-assisted method for the management of upper gastrointestinal obstruction to avoid technical failure. Clin Endosc 2013; 46:373-8. [PMID: 23964334 PMCID: PMC3746142 DOI: 10.5946/ce.2013.46.4.373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/15/2012] [Accepted: 11/27/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIMS Endoscopic management of upper gastrointestinal obstruction is safe and feasible. However, its technical and clinical success rate is about 90%, which is primarily due to inability to pass a guide-wire through the stricture. The aim of this study was to evaluate the usefulness of an ultrathin endoscope for correct placement of guide wire to avoid technical failure in upper gastrointestinal obstruction. METHODS Retrospective assessment of ultrathin endoscope to traverse the stenosis of the upper gastrointestinal tract in technically difficult cases was performed. Technical and clinical success rates and immediate complications were analyzed. RESULTS Nine cases were included in this study (eight cases of stent insertion and one case of balloon dilatation). Technical success was achieved in all of the patients (100%) and oral feeding was feasible in all of the cases (100%). Immediate complications, such as migration, perforation, and hemorrhage, did not develop in any of the cases. CONCLUSIONS Ultrathin endoscope-assisted method for upper gastrointestinal obstruction is potentially safe and useful to avoid technical failure.
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Affiliation(s)
- Jong In Kim
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Abstract
AIM The present prospective observational study investigates the safety of transnasal percutaneous endoscopic gastrostomy (T-PEG) carried out by a single physician using an ultrathin endoscope. METHODS A single endoscopist attempted the unsedated transnasal insertion of a 20-Fr PEG tube using a pull-method in 31 dysphagic patients: 11 females and 20 males aged 76.5±10.6(46-96)years, using a 5-mm-diameter endoscope. The indications for PEG, cardiopulmonary function before and after T-PEG, operation time, success or failure, and any immediate adverse events that occurred during each procedure were recorded. Complications, including peristomal infection, systemic infection, tube lifespan, and patient mortality were monitored throughout the post-T-PEG follow-up period. RESULTS Thirty (96.8%) of the transnasal PEG insertions were successful. The mean operation time was 14.7±2.9 (10-20) min, and cardiopulmonary function did not change before and after T-PEG. Complications included three (10%) cases of epistaxis, eight (26.6%) cases of minor Pseudomonas wound infection and two cases of Foley-related urinary tract infection (UTI). No self-extubation was observed, and the mean lifespan of the PEG tubes was 10.7±2.2months. Four patients died from pneumonia 10months after T-PEG insertion. CONCLUSION Unsedated T-PEG insertion carried out by a single physician is a feasible and safe procedure. No major complications or mortality were observed following the procedures; only minor Pseudomonas aeruginosa wound infections were noted. It is an alternative method for dysphagic patients when transoral insertion of endoscopy is impossible.
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Affiliation(s)
- Lian-Feng Lin
- Division of Gastroenterology, Department of Internal Medicine, Pingtung Christian Hospital, Taiwan.
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Tsuboi M, Arai M, Maruoka D, Matsumura T, Nakagawa T, Katsuno T, Yokosuka O. Utility and stability of transnasal endoscopy for examination of the pharynx - a prospective study and comparison with transoral endoscopy. Int J Med Sci 2013; 10:1085-91. [PMID: 23869183 PMCID: PMC3714383 DOI: 10.7150/ijms.6003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 06/18/2013] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Transnasal endoscopy may be used to observe the head and neck part readily without excessive reflexes. We aimed to evaluate the utility and stability of transnasal esophagogastroduodenoscopy (TN-EGD) in comparison with transoral EGD (TO-EGD) for observation of the pharynx. STUDY DESIGN Prospective study METHODS A total of 497 patients received unsedated TN-EGD with a 5.5 mm diameter endoscope or unsedated TO-EGD with endoscopes of 6.5 mm, 7.9 mm and 9.2 mm diameter. The rate of completion of pharyngeal observation and numbers of gag reflexes and cough reflexes were recorded. RESULTS TN-EGD was performed in 175 patients and TO-EGD was performed in 322 patients. Pharyngeal observation was completed in 173 patients (98.9%) in the TN-EGD group and 235 patients (73.2%) in the TO-EGD group, a significant difference (p<0.001). The TN-EGD group had a low rate of occurrence of gag reflex (0.57%), in contrast, 28.3% of the TO-EGD group had a gag reflex, a significant difference (p<0.01). Multivariable analyses revealed that the use of TN-EGD was the only predictive factor for completion of pharyngeal observation (p<0.0001). CONCLUSIONS TN-EGD is ideally suited to observation of the pharynx by unsedated EGD.
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Affiliation(s)
- Masaru Tsuboi
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Jeon SJ, Shin SJ, Lee KM, Lim SK, Lee YC, Lee MH, Hwang JC, Cheong JY, Yoo BM, Kim JH. Can the 1.8 mm transnasal biopsy forceps instead of standard 2.2 mm alter rapid urease test and histological diagnosis? J Gastroenterol Hepatol 2012; 27:1384-7. [PMID: 22497665 DOI: 10.1111/j.1440-1746.2012.07152.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIM Biopsy specimens are taken during transnasal esophagogastroduodenoscopy with 1.8 mm forceps. The aims of this study were to compare the concordance of the Campylobacter-like organism (CLO) test and histological diagnoses between biopsies taken with 1.8 mm and 2.2 mm forceps and to determine whether the concordance of the CLO test could be improved by increasing the number of specimens using 1.8 mm forceps. METHODS A total of 200 patients were enrolled. We first performed the CLO test twice using each sample taken with both forceps in 100 patients. The CLO test was conducted three times again after confirming the difference in the CLO test between two forceps: (i) one sample with 1.8 mm forceps; (ii) two with 1.8 mm; and (iii) one with 2.2 mm in the other 100 patients. Additionally, each specimen was taken from the same gastric lesions in 200 patients for the histological diagnosis using both forceps types. RESULTS The concordance rate of the CLO test between each sample with 1.8 mm and 2.2 mm forceps was 83% (κ-value, 0.64), and that between two samples with 1.8 mm and one with 2.2 mm was 92% (κ-value, 0.83). The concordance rate of the histological diagnosis with 1.8 and 2.2 mm was 97% (κ-value, 0.84). CONCLUSIONS At least two samples using 1.8 mm forceps might be needed to obtain similar results on the CLO test using 2.2 mm. But, the size difference between two forceps did not influence the histological diagnosis.
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Affiliation(s)
- Su Jin Jeon
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
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Zhang L, Huang YH, Yao W, Chang H, Guo CJ, Lin SR. Transnasal esophagogastroduodenoscopy for placement of nasoenteric feeding tubes in patients with severe upper gastrointestinal diseases. J Dig Dis 2012; 13:310-5. [PMID: 22624554 DOI: 10.1111/j.1751-2980.2012.00594.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of small-caliber transnasal esophagogastroduodenoscopy for the placement of nasoenteric feeding tubes (NET) in patients with severe upper gastrointestinal (GI) diseases. METHODS Between January 2007 and March 2010, 51 patients underwent transnasal endoscopy for the placement of NET in Peking University Third Hospital. Indications for NET included esophageal stricture or gastric outlet obstruction because of corrosive esophagitis or gastritis, partial obstruction due to malignancy, stenosis in stoma or efferent loop, gastroparesis, metallic stent in upper GI tract, tracheoesophageal fistula, severe acute pancreatitis, anorexia nervosa and intensive care patients. The tubes were endoscopically placed using the guidewire technique. The position of the tube was confirmed by the immediate second endoscopy or abdominal X-ray. If the initiate placement was not correct, an adjustment or a second placement was conducted immediately. RESULTS Initial post-pyloric placement of NET was achieved in 43 of 51 patients (84.3%), but the total success rate reached 98.0% (50/51) after the second placement. The time required for the procedure ranged from 10 to 35 min, with a median time of 20.4 min. Epistaxis occurred in 2 patients. There were no complications of hemorrhage, perforation or aspiration. CONCLUSION The transnasal endoscopic placement of NET was feasible in patients with upper GI diseases, especially in those with changed anatomy.
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Affiliation(s)
- Li Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
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Abstract
BACKGROUND AND AIM The assessment and treatment of advanced gastrointestinal (GI) strictures, which are defined as the inability to pass through the strictured segment with standard endoscopes, might require radiological work-up, repeated endoscopies and surgery. The aim of the present study was to assess the role of ultrathin endoscopy (UTE) for the evaluation and treatment of advanced GI strictures. METHODS Patients in whom an initial diagnostic upper or lower endoscopy attempt was incomplete because of a tight stricture underwent a second procedure with a UTE (5.9 mm diameter) in the same session. An interventional endoscopic therapy was also carried out according to the etiology and nature of the stricture using the same UTE. Diagnostic and therapeutic outcomes were recorded and followed up prospectively. The study was conducted in a tertiary endoscopy center. RESULTS During a one and half year study period, 62 patients (51 at upper and 11 at lower endoscopy) were detected with advanced GI stricture among 8456 diagnostic upper and 3815 lower endoscopy patients. A complete endoscopic examination was successful with UTE in 40 (78%) patients with upper and in nine patients (82%) with lower GI strictures. An interventional procedure was also carried out in 16 patients with the assistance of UTE. CONCLUSION UTE is a useful tool for the evaluation of patients with advanced GI strictures. It provides a complete diagnostic endoscopy in most patients and gives an opportunity for therapeutic endoscopic procedures.
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Affiliation(s)
- Musa Aydinli
- Department of Gastroenterology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey.
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Peery AF, Hoppo T, Garman KS, Dellon ES, Daugherty N, Bream S, Sanz AF, Davison J, Spacek M, Connors D, Faulx AL, Chak A, Luketich JD, Shaheen NJ, Jobe BA. Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video). Gastrointest Endosc 2012; 75:945-953.e2. [PMID: 22425272 PMCID: PMC4154478 DOI: 10.1016/j.gie.2012.01.021] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 01/12/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Endoscopic screening for esophageal neoplasia can identify patients eligible for early intervention for precancerous lesions. Unsedated transnasal esophagoscopy may provide an efficient and accurate endoscopic assessment with fewer risks and less cost, compared with conventional upper endoscopy. OBJECTIVE To assess the feasibility, safety, acceptability, and yield of unsedated transnasal esophagoscopy in a primary care population. DESIGN Multicenter, prospective, cross-sectional study. SETTING Two outpatient tertiary-care centers. PATIENTS This study involved a general medical clinic population aged between 40 and 85 years. INTERVENTION Unsedated, office-based transnasal esophagoscopy. MAIN OUTCOME MEASUREMENTS Procedure yield; completeness of examination; procedure length; adverse events and complications; choking, gagging, pain, or anxiety during the examination; and overall tolerability. RESULTS A total of 426 participants (mean [± standard deviation] age 55.8 ± 9.5 years; 43% male) enrolled in the study, and 422 (99%) completed the examination. Mean (± standard deviation) examination time was 3.7 ± 1.8 minutes. There were no serious adverse events, and 12 participants (2.8%) reported minor complications. Participants reported minimal choking, gagging, pain, or anxiety. The examination was well-tolerated by most participants. Overall, 38% of participants had an esophageal finding that changed management (34% erosive esophagitis, 4% Barrett's esophagus). LIMITATIONS Nonrandomized study, tertiary-care centers only, self-selected population with a large proportion reporting esophageal symptoms. CONCLUSION Unsedated transnasal esophagoscopy is a feasible, safe, and well-tolerated method to screen for esophageal disease in a primary care population. Endoscopic findings are common in this patient population.
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Affiliation(s)
- Anne F. Peery
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Evan S. Dellon
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Norma Daugherty
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Susan Bream
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Melissa Spacek
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Shariff MK, Bird-Lieberman EL, O'Donovan M, Abdullahi Z, Liu X, Blazeby J, Fitzgerald R. Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus. Gastrointest Endosc 2012; 75:954-61. [PMID: 22421496 DOI: 10.1016/j.gie.2012.01.029] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 01/19/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unsedated transnasal endoscopy (TNE) may be safer and less expensive than standard endoscopy (SE) for detecting Barrett's esophagus (BE). Emerging technologies require robust evaluation before routine use. OBJECTIVE To evaluate the sensitivity, specificity, and acceptability of TNE in diagnosing BE compared with those of SE. DESIGN Prospective, randomized, crossover study. SETTING Single, tertiary-care referral center. PATIENTS This study enrolled consecutive patients with BE or those referred for diagnostic assessment. INTERVENTION All patients underwent TNE followed by SE or the reverse. Spielberger State-Trait Anxiety Inventory short-form questionnaires, a visual analogue scale, and a single question addressing preference for endoscopy type were administered. MAIN OUTCOME MEASUREMENTS Diagnostic accuracy and tolerability of TNE were compared with those of SE. RESULTS Of 95 patients randomized, 82 completed the study. We correctly diagnosed 48 of 49 BE cases by TNE for endoscopic findings of columnar lined esophagus compared with the criterion standard, SE, giving a sensitivity and specificity of 0.98 and 1.00, respectively. The BE median length was 3 cm (interquartile range [IQR] 1-5 cm) with SE and 3 cm (IQR 2-4 cm) with TNE, giving high correlations between the two modalities (R(2) = 0.97; P < .001). The sensitivity and specificity for detecting intestinal metaplasia by TNE compared with those by SE was 0.91 and 1.00, respectively. The mean (± standard deviation) post-endoscopy Spielberger State-Trait Anxiety Inventory short-form score for TNE (30.0 ± 1.10 standard error of the mean [SEM]) was lower than that for SE (30.7 ± 1.29 SEM), (P = .054). The visual analogue scale scores were no different (P = .07). The majority of patients (59%) expressed a preference for TNE. LIMITATIONS This is a small study, with limited generalizability, a high prevalence of patients with BE, differential drop-out between the two procedures, and use of sedation. CONCLUSION TNE is an accurate and well-tolerated method for diagnosing BE compared with SE. TNE warrants further evaluation as a screening tool for BE.
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Affiliation(s)
- M Kareem Shariff
- MRC Cancer Cell Unit, Hutchison-MRC Research Centre, Cambridge, United Kingdom
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Shahmoon A, Slovin H, Zalevsky Z. Biomedical Super-resolved Imaging Using Special Micro-probe. BioNanoSci 2011. [DOI: 10.1007/s12668-011-0012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kawai T, Takagi Y, Fukuzawa M, Yamagishi T, Goto S. The role of trefoil factor family in apparently healthy subjects administrated gastroprotective agents for the primary prevention of gastrointestinal injuries from low-dose acetylsalicylic acid: a preliminary study. J Clin Biochem Nutr 2011; 49:136-40. [PMID: 21980231 PMCID: PMC3171679 DOI: 10.3164/jcbn.11-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 02/09/2011] [Indexed: 12/21/2022] Open
Abstract
It is well-known that acetylsalicylic acid induces gastrointestinal complication. Recently, trefoil factor family has been reported as a mucosal protective factor. We focused on trefoil factor family as one of defensive system for gastrointestinal injuries. The aim of this trial was to evaluate trefoil factor family levels in the serum of healthy subjects with low-dose acetylsalicylic acid. Low-dose acetylsalicylic acid with placebo or proton pump inhibitor or rebamipide were administered in 30 healthy subjects. Transnasal endoscopy was performed at 0, 24 h, 3 and 7 day. Changing of trefoil factor family (1,2,3) and numbers of gastric injuries were evaluated. The numbers of gastric injuries were significantly increased in the placebo group at 3 and 7 days. Injuries in the proton pump inhibitor group were not induced, in the rebamipide group were slightly induced. Trefoil factor family level in the placebo group were decreased in 3 and 7 days compared with prior to starting the trial. Trefoil factor family may have an important association with acetylsalicylic acid-induced gastrointestinal damage. Proton pump inhibitor and rebamipide prevented low-dose acetylsalicylic acid-induced gastrointestinal complications compared with the placebo group.
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Affiliation(s)
- Takashi Kawai
- Endoscopy Center, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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Walter T, Chesnay AL, Dumortier J, Mège-LeChevallier F, Hervieu V, Guillaud O, Lapalus MG, Lépilliez V, Fumex F, Ponchon T, Scoazec JY. Biopsy specimens obtained with small-caliber endoscopes have comparable diagnostic performances than those obtained with conventional endoscopes: a prospective study on 1335 specimens. J Clin Gastroenterol 2010; 44:12-7. [PMID: 19661817 DOI: 10.1097/MCG.0b013e3181a1bebd] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND STUDY AIMS Esophagogastroduodenoscopy (EGD) can be routinely performed via a nasal route in adults by using small-caliber endoscopes. The aim of this study was to evaluate the adequacy of biopsy specimens obtained with small forceps for histologic diagnosis. PATIENTS AND METHODS From January to April 2007, we prospectively compared all biopsy specimens obtained, during conventional EGD (8.8-mm-diameter endoscope), with (CS-EGD) or without sedation (C-EGD), and transnasal or transoral-EGD (4.9-mm-diameter endoscope) without sedation (T-EGD). All biopsy specimens were blindly evaluated by a pathologist. For each specimen, were recorded: site, biopsy size and thickness, type of lesion (focal or diffuse), and in case of focal abnormalities described by the endoscopist, presence of the histologic lesions in the targeted biopsies. RESULTS One thousand and thirty-five biopsy specimens were obtained from 300 procedures (109 T-EGD, 48 C-EGD, and 143 CS-EGD): 983 biopsy specimens were untargeted (esophagus and cardia in 21%, stomach in 85% and duodenum in 84%) and 352 biopsy specimens were targeted to focal lesions (esophagus and cardia in 79%, stomach in 15%, and duodenum in 16%). The mean size of specimens was 1.8, 2, 2.2 mm diameter, in T-EGD, C-EGD, and CS-EGD groups, respectively (P<0.001). The whole thickness of mucosa was present in 68%, 84%, 71% of the cases among T-EGD, C-EGD, and CS-EGD groups, respectively (P=0.9). There was no significant difference in the rate of definitive histologic diagnosis from targeted or nontargeted biopsies according to the endoscopic procedure. CONCLUSIONS Biopsy specimens obtained during EGD with small forceps are as effective for diagnosis as those obtained with standard forceps.
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Hu CT. Gauze pledgetting versus endoscopic-guided aerosolized spray for nasal anesthesia before transnasal EGD: a prospective, randomized study. Gastrointest Endosc 2010; 71:11-20. [PMID: 19748613 DOI: 10.1016/j.gie.2009.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 06/14/2009] [Indexed: 12/10/2022]
Abstract
BACKGROUND Methods and efficacy of nasal anesthesia before ultrathin transnasal EGD (UT-EGD) are crucial for patient tolerance. OBJECTIVE To compare patient tolerance, safety, and adverse events between cotton-tipped applicator primed gauze pledgetting (CTGP) and endoscopic-guided aerosolized spray (EGAS) methods of nasal anesthesia. DESIGN We performed a prospective, randomized-controlled trial to compare procedural discomforts, optical quality, total procedure time, and adverse events between the CTGP and EGAS methods. SETTING A large, tertiary referral hospital in Taiwan. PATIENTS A total of 240 consecutive patients with epigastric discomfort were included in the study. INTERVENTION The author performed all standardized nasal anesthesia and UT-EGD using a 5.9-mm diameter transnasal endoscope. MAIN OUTCOME MEASUREMENTS Technical success, patient tolerability profiles, optical quality, total procedure time, and adverse events. RESULTS There was no statistical difference in insertion failure rates between the 2 methods (CTGP 0% vs EGAS 5%, P = .07). When compared with the EGAS method, CTGP reduced pain during insertions through the inferior nasal meatus (3.4 +/- 0.5 vs 3.2 +/- 0.4, P = .006), middle nasal meatus (4.0 +/- 0.7 vs 3.4 +/- 0.5, P = .002), and upper esophageal sphincter (2.9 +/- 0.7 vs 2.6 +/- 0.8, P = .005). CTGP elicited less unpleasant taste, fewer gagging episodes, and less throat pain after examination. Both methods had similar safe hemodynamic profiles, low epistaxis rates (0% vs 2%, P = .46), and comparable visual capacity and procedure time. Although similar proportions of patients in both groups would like to receive the same procedure the next time, CTGP had a higher overall tolerance. CONCLUSION Compared with the EGAS method, CTGP achieved a better tolerability profile and elicited less bad taste, fewer gagging episodes, and less throat pain after UT-EGD in Taiwanese patients.
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Affiliation(s)
- Chi-Tan Hu
- Division of Gastroenterology and Research Centre for Hepatology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Graduate Institute of Clinical Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Yuki M, Amano Y, Komazawa Y, Fukuhara H, Shizuku T, Yamamoto S, Kinoshita Y. Unsedated transnasal small-caliber esophagogastroduodenoscopy in elderly and bedridden patients. World J Gastroenterol 2009; 15:5586-91. [PMID: 19938199 PMCID: PMC2785063 DOI: 10.3748/wjg.15.5586] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the safety of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) for elderly and critically ill bedridden patients.
METHODS: One prospective randomized comparative study and one crossover comparative study between transnasal small-caliber EGD and transoral conventional EGD was done (Study 1). For the comparative study, we enrolled 240 elderly patients aged > 65 years old. For the crossover analysis, we enrolled 30 bedridden patients with percutaneous endoscopic gastrostomy (PEG) (Study 2). We evaluated cardiopulmonary effects by measuring arterial oxygen saturation (SpO2) and calculating the rate-pressure product (RPP) (pulse rate × systolic blood pressure/100) at baseline, 2 and 5 min after endoscopic intubation in Study 1. To assess the risk for endoscopy-related aspiration pneumonia during EGD, we also measured blood leukocyte counts and serum C-reactive protein (CRP) levels before and 3 d after EGD in Study 2.
RESULTS: In Study 1, we observed significant decreases in SpO2 during conventional transoral EGD, but not during transnasal small-caliber EGD (0.24% vs -0.24% after 2 min, and 0.18% vs -0.29% after 5 min, P = 0.034, P = 0.044). Significant differences of the RPP were not found between conventional transoral and transnasal small-caliber EGD. In Study 2, crossover analysis showed statistically significant increases of the RPP at 2 min after intubation and the end of endoscopy (26.8 and 34.6 vs 3.1 and 15.2, P = 0.044, P = 0.046), and decreases of SpO2 (-0.8% vs -0.1%, P = 0.042) during EGD with transoral conventional in comparison with transnasal small-caliber endoscopy. Thus, for bedridden patients with PEG feeding, who were examined in the supine position, transoral conventional EGD more severely suppressed cardiopulmonary function than transnasal small-caliber EGD. There were also significant increases in the markers of inflammation, blood leukocyte counts and serum CRP values, in bedridden patients after transoral conventional EGD, but not after transnasal small-caliber EGD performed with the patient in the supine position. Leukocyte count increased from 6053 ± 1975/L to 6900 ± 3392/L (P = 0.0008) and CRP values increased from 0.93 ± 0.24 to 2.49 ± 0.91 mg/dL (P = 0.0005) at 3 d after transoral conventional EGD. Aspiration pneumonia, possibly caused by the endoscopic examination, was found subsequently in two of 30 patients after transoral conventional EGD.
CONCLUSION: Transnasal small-caliber EGD is a safer method than transoral conventional EGD in critically ill, bedridden patients who are undergoing PEG feeding.
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Horiuchi A, Nakayama Y, Hidaka N, Ichise Y, Kajiyama M, Tanaka N. Prospective comparison between sedated high-definition oral and unsedated ultrathin transnasal esophagogastroduodenoscopy in the same subjects: pilot study. Dig Endosc 2009; 21:24-8. [PMID: 19691797 DOI: 10.1111/j.1443-1661.2008.00826.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Recently, quality as well as acceptability has been a concern regarding endoscopy. The aim of the present study was to compare the acceptability and quality of sedated high-definition esophagogastroduodenoscopy (sHD-EGD) using a newly developed high-definition videoscope with those of unsedated ultrathin esophagogastroduodenoscopy (uUT-EGD) using a 5.2 mm videoscope. METHODS Twenty-two volunteers underwent both peroral sHD-EGD and transnasal uUT-EGD on the same day. Sedation consisted of 40 mg of propofol i.v. Both endoscopist and subject satisfaction levels were assessed using a 10 cm visual analogue scale. RESULTS All 22 subjects completed the sHD-EGD and 21 subjects completed the uUT-EGD. The endoscopist and subject satisfaction levels of sHD-EGD were significantly better than those of uUT-EGD (overall endoscopist satisfaction: 9 vs 4, P < 0.0001; overall subject satisfaction: 9 vs 3, P < 0.0001). The optical quality of the endoscopic images of sHD-EGD was significantly higher than that of uUT-EGD except in the duodenal bulb (overall quality: 8 vs 7, P < 0.0001). The interobserver agreement for EGD findings in sHD-EGD was better than with uUT-EGD, although the EGD findings in both sHD-EGD and uUT-EGD were similar. After undergoing both procedures, 91% were willing to have sHD-EGD again compared to 9% with uUT-EGD. CONCLUSIONS The endoscopist and subject satisfaction levels and image quality of sHD-EGD were better than those of uUT-EGD. The routine use of high-definition videoscopes would be expected to provide better acceptability than that obtained with unsedated endoscopy.
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Affiliation(s)
- Akira Horiuchi
- Department of Gastroenterology, Showa Inan General Hospital, Komagane, Japan.
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Kawai T, Yamagishi T, Shinya Goto SG. Circadian Variations of Gastrointestinal Mucosal Damage Detected with Transnasal Endoscopy in Apparently Healthy Subjects Treated with Low-Dose Aspirin (ASA) for a Short Period. J Atheroscler Thromb 2009; 16:155-63. [DOI: 10.5551/jat.e615] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Takashi Kawai
- Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan
| | | | - Shinya Goto Shinya Goto
- Department of Medicine and Metabolic Disease Center, Tokai University School of Medicine, Tokyo, Japan
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Murata A, Akahoshi K, Motomura Y, Matsui N, Kubokawa M, Kimura M, Ouchi J, Honda K, Endo S, Nakamura K, Takayanagi R. Prospective comparative study on the acceptability of unsedated transnasal endoscopy in younger versus older patients. J Clin Gastroenterol 2008; 42:965-8. [PMID: 18622302 DOI: 10.1097/MCG.0b013e318126bb19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOALS The aim of this prospective study was to compare the acceptance and tolerance for unsedated transnasal esophagogastroduodenoscopy (EGD) between younger and older patients. BACKGROUND Little information is available on comparisons of younger and older patients with regard to acceptance and tolerance of transnasal EGD. STUDY A total of 260 patients were referred for unsedated transnasal EGD and divided into 2 groups according to their age: less than 60 years of age (group A, n=160) and 60 years of age and older (group B, n=100). A questionnaire for tolerance was completed by each patient (a validated 0 to 10 scale where "0" represents no discomfort/well tolerated and "10" represents severe discomfort/poorly tolerated). RESULTS In 94.4% of group A and 95.0% of group B, insertions were successfully completed (P>0.05). Between groups A and B, discomfort during nasal anesthesia (1.7+/-0.2 vs. 1.6+/-0.2) and overall tolerance during procedure (1.7+/-0.2 vs. 1.5+/-0.2) were similar (P>0.05). However, discomfort during insertion was significantly greater in group A than in group B (2.5+/-0.2 vs. 1.9+/-0.2, P=0.02). Of all, 97.4% of group A and 94.7% of group B were willing to undergo unsedated transnasal EGD in the future (P>0.05). CONCLUSIONS There was no significant difference in acceptability between younger and older patients for unsedated transnasal EGD. Otherwise, younger patients experienced significantly more discomfort during insertion than did older patients.
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Dumonceau JM, Dumortier J, Deviere J, Kahaleh M, Ponchon T, Maffei M, Costamagna G. Transnasal OGD: practice survey and impact of a live video retransmission. Dig Liver Dis 2008; 40:776-83. [PMID: 18436491 DOI: 10.1016/j.dld.2008.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 03/02/2008] [Accepted: 03/03/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Unsedated transnasal oesogastroduodenoscopy significantly improves patient tolerance compared to unsedated conventional peroral oesogastroduodenoscopy. AIMS To assess the adoption of transnasal oesogastroduodenoscopy among endoscopists from various European countries and its determinants. METHODS A survey was distributed to 624 endoscopists attending a live course on digestive endoscopy; a poll was also performed immediately before and after live video retransmission of a transnasal oesogastroduodenoscopy. RESULTS Answer rate was 48%; transnasal oesogastroduodenoscopy was practised by 31% of respondents. In multivariate analysis, practice of transnasal oesogastroduodenoscopy was associated with location in France and Netherlands (P<0.0001), availability of many gastroscopes (P<0.0001) and less frequent use of sedation (P=0.006). Endoscopists who did not practise transnasal oesogastroduodenoscopy cited doubts about its advantages over conventional oesogastroduodenoscopy and lack of training (34% each) as barriers to adoption. Seventy-four percent of endoscopists practicing transnasal oesogastroduodenoscopy did actually use it in <20% of eligible cases. Live video retransmission of a transnasal oesogastroduodenoscopy increased the proportion of endoscopists interested in this technique (P=0.006). CONCLUSIONS Adoption of transnasal oesogastroduodenoscopy largely varies between European countries; endoscopists practicing this technique use it in a minority of eligible cases. Live case demonstration may decrease barriers to the adoption of this technique.
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Affiliation(s)
- J M Dumonceau
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Micheli-du-Crest Street 24, 1205 Geneva, Switzerland.
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Stroppa I, Grasso E, Paoluzi OA, Razzini C, Tosti C, Andrei F, Biancone L, Palmieri G, Romeo F, Pallone F. Unsedated transnasal versus transoral sedated upper gastrointestinal endoscopy: a one-series prospective study on safety and patient acceptability. Dig Liver Dis 2008; 40:767-75. [PMID: 18424197 DOI: 10.1016/j.dld.2008.02.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 02/14/2008] [Accepted: 02/18/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND While conventional oesophagogastroduodenoscopy is frequently performed under sedation to improve acceptability, transnasal oesophagogastroduodenoscopy would appear to be less invasive. STUDY AIMS To compare diagnostic accuracy, feasibility, acceptability and safety of transnasal oesophagogastroduodenoscopy without sedation versus conventional oesophagogastroduodenoscopy under sedation. PATIENTS Following anxiety assessment, 30 dyspeptic patients underwent transnasal oesophagogastroduodenoscopy under local anaesthesia (lidocaine) and conventional oesophagogastroduodenoscopy under conscious sedation (i.v. midazolam) on two consecutive days. Transnasal oesophagogastroduodenoscopy was performed with an ultrathin and conventional oesophagogastroduodenoscopy with a standard endoscope. METHODS Safety, evaluated by monitoring cardio-respiratory functions. Acceptability, rated according to discomfort and preference between the two examinations. Diagnostic accuracy evaluated taking into account endoscopic patterns and adequacy of biopsy specimens for histology. Feasibility, defined according to endoscopic performance, quality of images and overall opinion of the endoscopist. Only gastric biopsies were evaluated. RESULTS All patients but one who refused conventional oesophagogastroduodenoscopy underwent both transnasal oesophagogastroduodenoscopy and conventional oesophagogastroduodenoscopy. No cardiorespiratory complications occurred during either technique. Majority of patients (87%) preferred transnasal oesophagogastroduodenoscopy. Examinations were completed in all cases, with comparable endoscopic patterns. All biopsy specimens were suitable for histology. CONCLUSIONS Transnasal oesophagogastroduodenoscopy without sedation provides good diagnostic accuracy, is safer and better accepted than conventional oesophagogastroduodenoscopy under sedation and, therefore, represents a valid alternative in routine diagnosis of upper digestive tract diseases.
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Affiliation(s)
- I Stroppa
- Gastrointestinal Unit, Department of Internal Medicine, Tor Vergata University, Rome, Italy.
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Tatsumi Y, Harada A, Matsumoto T, Tani T, Nishida H. Feasibility and tolerance of 2-way and 4-way angulation videoscopes for unsedated patients undergoing transnasal EGD in GI cancer screening. Gastrointest Endosc 2008; 67:1021-7. [PMID: 18279865 DOI: 10.1016/j.gie.2007.10.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 10/06/2007] [Indexed: 01/28/2023]
Abstract
BACKGROUND The differences between 2-way and 4-way angulation endoscopes for use in unsedated patients undergoing transnasal EGD have not been elucidated. OBJECTIVE Our purpose was to evaluate the feasibility and tolerance of 2- and 4-way angulation endoscopes for unsedated transnasal EGD in GI cancer screening of elderly people. DESIGN A total of 291 patients were randomized to receive unsedated transnasal EGD with a 5.2-mm diameter 2-way angulation endoscope (GIF-N260, Olympus, Tokyo, Japan) (n = 146) or 5.5-mm diameter 4-way angulation endoscope (XGIF-XP240N2, Olympus) (n = 145). The transnasal insertion success rate and incidence of epistaxis were compared. The following parameters were evaluated: overall quality of the examination, ease of passing the endoscope through the pylorus, intubation of the second portion of the duodenum, ability to observe the entire upper GI tract and perform target biopsy, and examination time. Patient tolerance and acceptance were also assessed with regard to nasal pain, choking, gagging, abdominal discomfort, and overall pain and discomfort. SETTING Matsushita Health Care Center, Moriguchi, Japan. PATIENTS A total of 291 patients had unsedated transnasal EGD as part of a gastric cancer screening program. RESULTS Use of the pediatric 4-way angulation endoscope significantly shortened the examination time when biopsy was performed compared with the 2-way angulation instrument, whereas the examination time without biopsy was not significantly different. Other parameters were not significantly different between the 2 endoscopes. CONCLUSION For unsedated transnasal EGD with biopsy, the 5.5-mm 4-way angulation videoscope shortens examination time while providing easy transnasal insertion and improved patient tolerance.
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Affiliation(s)
- Yoshihide Tatsumi
- Department of Gastrointestinal Diseases, Matsushita Health Care Center, Moriguchi, Japan
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Cho S, Arya N, Swan K, Cirocco M, Kandel G, Kortan P, Marcon N. Unsedated transnasal endoscopy: a Canadian experience in daily practice. Can J Gastroenterol 2008; 22:243-6. [PMID: 18354752 DOI: 10.1155/2008/514297] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Esophagogastroduodenoscopy (EGD) is the most frequently performed diagnostic procedure for upper gastrointestinal disorders. The procedure is routinely performed under conscious sedation in North America. A significant proportion of morbidity and mortality associated with EGD is related to hypoxia due to conscious sedation. The use of sedation is also associated with an increase in cost, loss of work on the day of endoscopy and the need for the patient to be accompanied home after the procedure. Transnasal endoscopy has advantages such as no sedation and less patient monitoring, nursing time and expenses than conventional per oral EGD. OBJECTIVES To assess the feasibility and acceptability of unsedated transnasal EGD in daily practice. METHODS Patients due to undergo EGD were given a choice of either unsedated transnasal EGD or per oral EGD with sedation. Patients who chose unsedated transnasal EGD had the procedure performed in the office by a senior gastroenterologist with experience in transnasal EGD. All procedures were performed using a small-calibre esophagogastroduodenoscope. All patients were surveyed using a patient satisfaction questionnaire, and were asked to give specific scores in terms of choking sensation, sore throat, nasal discomfort and abdominal discomfort. All variables were assessed by scores between 0 and 10, with 10 indicating the most severe degree of each variable. Any complications were also recorded. RESULTS Between March 2002 and August 2003, 231 patients underwent transnasal EGD. The median age of the patients was 57 years (range 15 to 87 years). Complete examinations were possible in 98% of patients. Patients reported a high degree of acceptability (mean score 6.6, range 1 to 10) and low degrees of choking sensation (mean 1.8, range 0 to 10), nasal discomfort (mean 1.7, range 0 to 10), sore throat (mean 0.8, range 0 to 9) and abdominal discomfort (mean 1.1, range 0 to 10). The only complications reported by the patients were epistaxis (n=2, 0.9%) and sinusitis (n=1, 0.4%). Some patients also reported transient light-headedness (n=12, 5%) and mucous discharge (n=2, 0.9%). When asked, 185 patients (88%) stated that they were willing to undergo the same procedure in the future if medically indicated. Of the 84 patients who had conventional EGD under conscious sedation in the past, 52 patients (62%) preferred transnasal EGD without sedation. CONCLUSIONS Transnasal EGD is generally well tolerated, feasible and safe. It can be performed with topical anesthesia in an outpatient setting. The low complication rate, high patient satisfaction and potential cost savings make transnasal endoscopy an attractive alternative to conventional EGD to screen patients for upper gastrointestinal tract diseases.
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Hu CT. Endoscopic-guided versus cotton-tipped applicator methods of nasal anesthesia for transnasal esophagogastroduodenoscopy: a randomized, prospective, controlled study. Am J Gastroenterol 2008; 103:1114-21. [PMID: 18445099 DOI: 10.1111/j.1572-0241.2007.01769.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ultrathin transnasal esophagogastroduodenoscopy (UT-EGD) is well tolerated by patients, but the methods of nasal anesthesia are various. AIM To compare patient tolerance, safety, and adverse events between the endoscopic-guided (EGNA) and cotton-tipped applicator (CTNA) methods of nasal anesthesia. METHODS Between September 2005 and September 2006, we conducted a prospective, randomized, controlled study in a large tertiary referral hospital in eastern Taiwan. In total, 235 consecutive patients were randomly assigned to the CTNA group or EGNA group before unsedated UT-EGD. We compared demographic data, procedural discomfort using a validated 5-point visual analog scale, optical quality, total procedure time, and adverse events between the two groups. RESULTS After randomization and exclusion, 101 (43 men and 58 women) and 103 (44 men and 59 women) patients were allocated to the CTNA and EGNA groups, respectively. Baseline characteristics and periprocedural hemodynamics of patients in the two groups were similar. There was no statistical difference in insertion failure rates between the two methods (CTNA 10.9%vs EGNA 7.7%, P= 0.59). Pain scores during both anesthesia (2.3 +/- 0.4 vs 3.5 +/- 0.6, P < 0.001) and insertion (2.8 +/- 1.2 vs 3.8 +/- 1.8, P < 0.001) were significantly lower in the EGNA group; however, the sensation of bad taste was significantly worse in the EGNA group (2.3 +/- 1.3 vs 1.9 +/- 1.4, P= 0.040). Less epistaxis happened in the EGNA group than in the CTNA group. The EGNA method had a significantly better visual capacity and shorter procedure time. More patients in the EGNA group said they would like to receive the same procedure the next time. CONCLUSION Compared with the CTNA method, in which the taste of lidocaine gel was more acceptable, EGNA appeared to be more tolerable, caused less epistaxis, improved visualization capacity, and reduced procedure time.
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Affiliation(s)
- Chi-Tan Hu
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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Maffei M, Dumortier J, Dumonceau JM. Self-training in unsedated transnasal EGD by endoscopists competent in standard peroral EGD: prospective assessment of the learning curve. Gastrointest Endosc 2008; 67:410-8. [PMID: 18155215 DOI: 10.1016/j.gie.2007.07.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 07/09/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Training programs in unsedated transnasal (UT) EGD are scarce. OBJECTIVE To prospectively assess the learning curve for unsupervised UT-EGD. SETTING Endoscopy service, without experience in UT-EGD. SUBJECTS Consecutive patients referred for diagnostic EGD. INTERVENTION UT-EGD was attempted in 140 study patients by 2 endoscopists who trained by themselves in UT-EGD (skilled endoscopist [n = 70]; a trainee having recently achieved competency in conventional EGD [n = 70]) and in 10 controls (endoscopist skilled in UT-EGD) by using a 4.9-mm-diameter videoendoscope. MAIN OUTCOME MEASUREMENTS Technical success, sedation administered, patient tolerance acceptance, procedure duration for each decade of 10 consecutive patients investigated by the same endoscopist; intention-to-treat analysis. RESULTS Both self-trained endoscopists fulfilled predefined criteria of competency in UT-EGD since the first attempts. They completed examinations of adequate quality with exclusive transnasal scope insertion (n = 139 [99.3%]), no sedation (n = 138 [98.6%]), and patient accepting repeat procedure (n = 135 [96.4%]) in proportions not significantly different from controls for all decades. Compared with a median procedure duration of 5.5 minutes (interquartile range [IQR] 5.0-8.5 minutes) in controls, procedures were significantly longer for all trainee's decades (eg, first decade 20.0 minutes [IQR 15.0-29.0 minutes], P < .001) but none for the skilled endoscopist. Overall discomfort, pain, gagging, and belching were not significantly different for study patients versus controls. Fifty-six of 69 study patients (81%) with a previous history of conventional EGD preferred UT-EGD. LIMITATIONS Generalizability to other small-caliber endoscopes. CONCLUSIONS Endoscopists competent in conventional EGD may obtain excellent results with UT-EGD (except for procedure duration) beginning with their first attempts, even without supervision or structured training.
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Dumortier J, Josso C, Roman S, Fumex F, Lepilliez V, Prost B, Lot M, Guillaud O, Petit-Laurent F, Lapalus MG, Ponchon T. Prospective evaluation of a new ultrathin one-plane bending videoendoscope for transnasal EGD: a comparative study on performance and tolerance. Gastrointest Endosc 2007; 66:13-9. [PMID: 17591468 DOI: 10.1016/j.gie.2006.11.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 11/27/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND EGD, with small-diameter endoscopes, is routinely performed via a nasal route in adults. OBJECTIVE To evaluate a new ultrathin one-plane bending videoendoscope for transnasal EGD. DESIGN Single center, prospective, randomized study. SETTING Edouard Herriot University Hospital. PATIENTS A total of 122 outpatients (median age, 49 years [18-81 years], 62 men and 60 women) were randomized into 2 groups (on a 2:1 basis) according to the endoscope used: (1) a standard 5.9-mm-diameter videoendoscope (80 patients) or (2) a one-plane bending high resolution 4.9-mm-diameter videoendoscope (42 patients). MAIN OUTCOME MEASUREMENTS The operator assessed the quality of examination by using standard scores or a 100-mm visual scale. Patients quantified tolerance by using a 100-mm visual scale. RESULTS The duration of the procedure was the same in each group. The feasibility of transnasal insertion was significantly higher when using the 4.9-mm-diameter endoscope (97.61% [41/42 patients] vs 88.75% [71/80 patients], P<.05). The tolerance of EGD was significantly better in the group with the small videoendoscope, for global discomfort, pain, belching, and bloating. Similarly, acceptation of a new EGD in similar conditions was higher in group 2 (92.9% vs 80%, P<.05). The quality of examination (global, lavage, inflation, suction) was not different between the 2 groups. LIMITATIONS Evaluation of patient tolerance and quality of examination was based on subjective features. CONCLUSIONS Availability of a new ultrathin one-plane bending videoendoscope represents a major technical improvement for transnasal EGD, which significantly improves both feasibility and patient tolerance, without affecting the quality of the examination.
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Affiliation(s)
- Jérôme Dumortier
- Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
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Murata A, Akahoshi K, Sumida Y, Yamamoto H, Nakamura K, Nawata H. Prospective randomized trial of transnasal versus peroral endoscopy using an ultrathin videoendoscope in unsedated patients. J Gastroenterol Hepatol 2007; 22:482-5. [PMID: 17376037 DOI: 10.1111/j.1440-1746.2006.04730.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM The aim of this study was to compare the acceptance and tolerance of transnasal and peroral esophagogastroduodenoscopy (EGD) using an ultrathin videoendoscope in unsedated patients. METHODS A total of 124 patients referred for diagnostic endoscopy were assigned randomly to have an unsedated transnasal EGD (n = 64) or peroral EGD (n = 60) with local anesthesia. An ultrathin videoendoscope with a diameter of 5.9 mm was used in this study. A questionnaire for tolerance was completed by the patient (a validated 0-10 scale where '0' represents no discomfort/well tolerated and '10' represents severe discomfort/poorly tolerated). RESULTS Of the 64 transnasal EGD patients, 60 patients (94%) had a complete examination. Four transnasal EGD examinations failed for anatomical reasons; all four patients were successfully examined when switched to the peroral EGD. All 60 peroral EGD patients had a complete examination. Between the transnasal and peroral groups, there was a statistically significant difference in scores for discomfort during local anesthesia (1.5 +/- 0.2 vs 2.6 +/- 0.3, P = 0.003), discomfort during insertion (2.3 +/- 0.3 vs 4.3 +/- 0.3, P = 0.001), and overall tolerance during procedure (1.6 +/- 0.2 vs 3.8 +/- 0.2, P = 0.001). In all, 95% of transnasal EGD patients and 75% of peroral EGD patients (P = 0.002) were willing to undergo the same procedure in the future. Four patients in the transnasal EGD group experienced mild epistaxis. CONCLUSION For unsedated endoscopy using an ultrathin videoendoscope, transnasal EGD is well tolerated and considerably reduces patient discomfort compared with peroral EGD.
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Affiliation(s)
- Atsuhiko Murata
- Department of Gastroenterology , Aso Iizuka Hospital, Iizuka, Japan
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Trevisani L, Cifalà V, Sartori S, Gilli G, Matarese G, Abbasciano V. Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice: A randomized trial. World J Gastroenterol 2007; 13:906-11. [PMID: 17352021 PMCID: PMC4065927 DOI: 10.3748/wjg.v13.i6.906] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
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 small-caliber 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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Affiliation(s)
- Lucio Trevisani
- Centro di Endoscopia Digestiva, Azienda Ospedaliera-Universitaria Arcispedale S. Anna, C.so Giovecca 203, Ferrara 44100, Italy.
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Alami RS, Schuster R, Friedland S, Curet MJ, Wren SM, Soetikno R, Morton JM, Safadi BY. Transnasal small-caliber esophagogastroduodenoscopy for preoperative evaluation of the high-risk morbidly obese patient. Surg Endosc 2007; 21:758-60. [PMID: 17235723 DOI: 10.1007/s00464-006-9101-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Accepted: 10/16/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Esophagogastroduodenoscopy (EGD) is an important facet of the preoperative evaluation for bariatric surgery. Morbidly obese patients are at high risk for airway complications during this procedure, and an attractive alternative is transnasal EGD. This report describes a series of patients evaluated successfully using this technique. METHODS All patients undergoing preoperative transnasal small-caliber EGD for morbid obesity surgery between September 2004 and June 2005 at a Veterans Affairs Hospital were included in the analysis. The variables assessed were the adequacy of the examination, patient tolerance, the need for sedation, and the ability to perform interventions. RESULTS The study enrolled 25 patients (17 men and 8 women) with an average age of 55 years (range, 44-63 years) and an average body mass index (BMI) of 47 kg/m2 (range, 38-69 kg/m2). All the patients met the 1991 National Institutes of Health (NIH) Consensus Conference Criteria for bariatric surgery and were undergoing preoperative evaluation. The most common comorbidities were hypertension (82%), diabetes mellitus (80%), and obstructive sleep apnea (68%). All 25 patients had successful cannulation of the duodenum's second portion with excellent tolerance. There were no sedation requirements for 23 (92%) of the 25 patients. Significant pathology was found in 14 (56%) of the 25 patients, including hiatal hernia (28%), gastritis (16%), esophageal intestinal metaplasia (16%), esophagitis (12%), gastric polyps (8%), gastric ulcer (4%) and esophageal varices (4%). Biopsies were indicated for 12 patients and successful for all 12 (100%). CONCLUSION Transnasal small-caliber EGD is a feasible and safe alternative to conventional EGD for the preoperative evaluation of patients undergoing bariatric surgery. It requires minimal to no sedation in a population at high risk for complications in this setting. In addition, this technique is effective in identifying pathology that requires preoperative treatment and offers a complete examination with biopsy capabilities. This technique should be considered for all morbidly obese patients at high risk for airway compromise during EGD.
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Affiliation(s)
- R S Alami
- Department of Surgery, Palo Alto Veterans Health Care System, 3801 Miranda Avenue, Palo Alto, CA, USA
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Jobe BA, Hunter JG, Chang EY, Kim CY, Eisen GM, Robinson JD, Diggs BS, O'Rourke RW, Rader AE, Schipper P, Sauer DA, Peters JH, Lieberman DA, Morris CD. Office-based unsedated small-caliber endoscopy is equivalent to conventional sedated endoscopy in screening and surveillance for Barrett's esophagus: a randomized and blinded comparison. Am J Gastroenterol 2006; 101:2693-703. [PMID: 17227516 DOI: 10.1111/j.1572-0241.2006.00890.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES A major limitation to screening and surveillance of Barrett's esophagus is the complexity, expense, and risk associated with sedation for upper endoscopy. This study examines the feasibility, accuracy, and patient acceptability of office-based unsedated endoscopy as an alternative. METHODS Of 274 eligible adults scheduled for endoscopic screening for gastroesophageal reflux symptoms or surveillance of Barrett's esophagus at a tertiary care center, 121 underwent unsedated small-caliber endoscopy and conventional endoscopy in a randomized crossover study. The two procedures were compared with regard to histological detection of Barrett's esophagus and dysplasia and biopsy size. Patients answered questionnaires assessing the tolerability of the procedures. RESULTS The prevalence of Barrett's esophagus was 26% using conventional endoscopy and 30% using unsedated endoscopy (P= 0.503). The level of agreement between the two approaches was "moderate" (kappa= 0.591). Each modality detected four cases of low-grade dysplasia with concordance on one case. The tissue samples collected with unsedated endoscopy were smaller than with conventional endoscopy (P < 0.001). The majority of subjects rated their experience with both procedures as being well tolerated with minimal or no difficulty. When asked which procedure they would prefer in the future, 71% (81/114) chose unsedated small-caliber endoscopy. CONCLUSIONS Office-based unsedated small-caliber endoscopy is technically feasible, well tolerated, and accurate in screening for Barrett's esophagus, despite yielding a smaller biopsy specimen. This approach bears the potential to eliminate the infrastructure and cost required for intravenous sedation in this application.
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Affiliation(s)
- Blair A Jobe
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
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Horiuchi A, Nakayama Y. Unsedated ultrathin EGD by using a 5.2-mm-diameter videoscope: evaluation of acceptability and diagnostic accuracy. Gastrointest Endosc 2006; 64:868-73. [PMID: 17140888 DOI: 10.1016/j.gie.2006.01.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Accepted: 01/02/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study was designed to assess the acceptability and the diagnostic accuracy of unsedated ultrathin EGD (uUT-EGD) by using a newly developed 5.2-mm-diameter videoscope compared with unsedated small-caliber EGD (uSC-EGD) by using a 6.5-mm-diameter videoscope or sedated conventional EGD (sC-EGD) by using a 9.0-mm-diameter videoscope. DESIGN First, 80 patients who had undergone uSC-EGD approximately 1 year earlier were randomized to receive uUT-EGD (n = 40) or uSC-EGD (n = 40). Endoscopist satisfaction and patient comfort were assessed by using a 10-cm visual analog scale. Patient comfort level was compared with that of the previous uSC-EGD. Second, 40 patients who had undergone sC-EGD within the previous 1.5 years underwent uUT-EGD. The optical quality and EGD findings of uUT-EGD were compared with those of the previous sC-EGD. Last, in the 80 patients undergoing uUT-EGD, the ability to identify a validated endoscopic marker, the rearrangement of collecting venues (RAC) pattern, for no Helicobacter pylori, was compared with the results of a (13)C-urea breath test or H pylori stool antigen test. SETTING Showa Inan General Hospital, Komagane, Japan. PATIENTS A total of 120 patients who undergo EGD every year as part of a gastric cancer surveillance program. RESULTS The patient comfort level of uUT-EGD was significantly better than that of uSC-EGD (P < .0001). The optical quality of the endoscopic images and the EGD findings of uUT-EGD were similar to those of the previous sC-EGD. The overall sensitivity, specificity, and accuracy of the RAC pattern in uUT-EGD in recognizing H pylori-uninfected patients were 90%, 100%, and 93%, respectively. The interobserver agreement for RAC was good (kappa = 0.42). CONCLUSIONS The use of a 5.2-mm-diameter videoscope is expected to enhance the patient acceptance of unsedated EGD.
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Affiliation(s)
- Akira Horiuchi
- Department of Gastroenterology, Showa Inan General Hospital, Komagane, Japan
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Lin CH, Liu NJ, Lee CS, Tang JH, Wei KL, Yang C, Sung KF, Cheng CL, Chiu CT, Chen PC. Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy. Gastrointest Endosc 2006; 64:104-7. [PMID: 16813813 DOI: 10.1016/j.gie.2005.12.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 12/28/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with esophageal cancer often present with dysphagia and malnutrition. Obstructive symptoms may improve after radiotherapy and chemotherapy. Nutrition support via a nasogastric tube (NG) or gastrostomy is very important during treatment. The newly developed ultrathin endoscope (Olympus, GIF-N230, outer diameter: 6 mm) has a smaller diameter than the standard endoscope and can be introduced into the esophagus via the nasal cavity. This article reports on the use of an ultrathin endoscope for NG placement for patients with esophageal cancer who presented with dysphagia and failed traditional NG tube placement. METHODS A consecutive series of 40 patients with esophageal cancer were referred to our hospital from November 2001 to October 2002 for endoscopic placement of NG tubes due to failure of traditional methods of NG placement. An ultrathin endoscope was used to advance the guidewire into the stomach via the nasal cavity. After withdrawal of the scope, the NG tube was inserted over the guidewire under fluoroscopy. OBSERVATIONS A total of 71 procedures were performed in 40 patients (37 males, 3 females), age 57 +/- 15 years (range, 37-91 y). Seventy procedures (99%) were successful in completing NG tube placement by using an ultrathin transnasal endoscope. Only one procedure failed because the esophageal lumen was completely occluded and the guidewire was not able to be passed through the obstructed site. The average duration that the NG tube was left in place was 49 +/- 35 days (range, 2-144 days). No procedure-related complications, such as bleeding or perforation, occurred. CONCLUSIONS Using ultrathin transnasal endoscopy to place an NG tube for esophageal cancer patients is effective and safe. It simplifies the procedures and increases the success rate.
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Affiliation(s)
- Cheng-Hui Lin
- Division of Digestive Therapeutic Endoscopy, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan
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Tajiri H. FUTURE PERSPECTIVES OF GASTROINTESTINAL ENDOSCOPY AND JOINT ACADEMIC-INDUSTRIAL RESEARCH FOLLOWING TECHNOLOGICAL INNOVATION IN MEDICAL AND BIOLOGICAL ENGINEERING. Dig Endosc 2005. [DOI: 10.1111/j.1443-1661.2005.00510.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Ciriza de los Ríos C, Fernández Eroles AL, García Menéndez L, Carneros Martín JA, Díez Hernández A, Delgado Gómez M. [Sedation in upper gastrointestinal endoscopy. Analysis of tolerance, complications and cost-effectiveness]. Gastroenterol Hepatol 2005; 28:2-9. [PMID: 15691461 DOI: 10.1157/13070376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND AIM Sedation of patients is an important complement to endoscopic procedures. The aim of this study was to analyze tolerance, complications and cost-effectiveness in patients undergoing diagnostic upper gastrointestinal endoscopy. PATIENTS AND METHOD A total of 357 patients were prospectively studied: 138 non-sedated, 116 sedated with midazolam and 103 sedated with midazolam and meperidine. Subjective tolerance, tolerance perceived by the endoscopist, complications, and cost-effectiveness were evaluated. The Chi-square test was used for the statistical analysis. P-values of less than 0.05 were considered statistically significant. RESULTS Subjective tolerance was greater in patients sedated with midazolam and meperidine than in the other groups (p < 0.05). Tolerance perceived by the endoscopist was greater in the group sedated with both drugs than in the group sedated with midazolam (p < 0.05). Subjective tolerance was better in sedated men and women but there was no association between sedation and perceived tolerance according to sex. Subjective tolerance was better in sedated patients older than 70 years than in those younger than 40 years (p < 0.05). Complications were more frequent in sedated patients and the most frequent complication in all the groups studied was mild desaturation; there was a significant difference between the group sedated with midazolam and meperidine and the non-sedated group (p < 0.05). Non-sedation had the best cost-effectiveness ratio but sedation with midazolam and meperidine was the most effective alternative. CONCLUSION From the point of view of the endoscopist, endoscopy can be performed without sedation, although subjective tolerance is greater in patients sedated with midazolam and meperidine. Non-sedation is more cost-effectiveness than sedation but if sedation is required midazolam and meperidine achieve better results in terms of effectiveness than midazolam alone.
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