Improvement of atropine on esophagogastric junction observation during sedative esophagogastroduodenoscopy

Abstract

Background and study aimsAlthough sedation esophagogastroduodenoscopy (EGD) is now widely used, previous research has reported that sedation during EGD exhibits a negative effect on esophagogastric junction (EGJ) exposure. Atropine might improve EGJ exposure, as noted in clinical practice. The aim of this study was to examine whether sedation had a negative effect on EGJ observation in the Chinese population, and whether atropine had some ability to act as an antidote to this unexpected secondary effect of sedation.Patients and methodsIn this cross-sectional study, subjects were divided into the following three groups according to the methods of EGD examination: the non-sedation group, the propofol-fentanyl combined sedation group and the combined sedation with atropine administration group. The EGJ observation was assessed by a key photograph taken with the endoscopic camera 1 cm from the EGJ, which was rated on the following four-degree scale: excellent (score = 4), good (score = 3), fair (score = 2) and poor (score = 1).ResultsThe EGJ exposure was better in the sedation group administered atropine (score = 2.64±1.05) than in the sedation group (score = 1.99±1.08, P<0.05) but not as good as in the non-sedation group (score = 3.24±1.12, P<0.05). Reduced detection of EGJ diseases in the sedation group was also found, compared to the non-sedation group (P<0.05). Only the use of atropine (OR = 2.381, 95%CI: 1.297–4.371, P = 0.005) was independently associated with excellent observation of the EGJ during sedation EGD.ConclusionsCombined propofol-fentanyl sedation reduces the extent of exposure of the EGJ during EGD and reduces the detection of EGJ diseases. The application of atropine in the sedation endoscopy examination helped to achieve better EGJ observation, but still cannot achieve an equal extent of exposure compared to non-sedation EGD.

A Randomized Comparative Study of the Effects of Pethidine and Midazolam on the Extent of Esophagogastric Junction Examination

“…4,5) However, sedation with midazolam and other drugs has been reported to make observation of the esophagogastric junction (EGJ) difficult (Figure 1), and several studies were conducted to resolve this problem. [6][7][8][9][10] There have also been a few studies on opioids, but so far, comparisons with pethidine are few, even though pethidine is the most frequently used analgesic in endoscopy. 11,12) The incidence of cancer at the EGJ is increasing worldwide, which means that examination at this site is increasing in importance.…”