Struggling toward easier endoscopy

Mokhashi, Mahesh S.; Hawes, Robert H.

doi:10.1016/s0016-5107(98)70021-5

Cited by 29 publications

(23 citation statements)

References 65 publications

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“…The fears and concerns associated with the endoscopic procedure decrease patient's compliance, making EGD execution more difficult [2][3][4] , and in many countries EGD is performed using conscious sedation [5] . Although usually safe, sedation is not free from adverse effects [6][7][8] , and produces a 30%-50% increase of the EGD costs, either direct (medications, additional time required to sedate and recover the patients, additional personnel needed to monitor the patients) or indirect (time lost from work by both the patient and patient's escort) [9,10] . N a r r ow-d i a m e te r e n d o s co p es ( < 6 m m) were developed in the early 1990s with the aim of reducing patient discomfort and avoiding the cost and risks of conscious sedation.…”

Section: Introductionmentioning

confidence: 99%

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

Trevisani

Cifalà²,

Sartori³

et al. 2007

WJG

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

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Section: Introductionmentioning

confidence: 99%

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

Trevisani

Cifalà²,

Sartori³

et al. 2007

WJG

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“…On the other hand, besides a discussion on the need and level of sedation desired for each exploration, it is clear that some minimum resources and basic knowledge are required for a safe management of sedation during endoscopy. In fact, sedation is responsible for between 30 and 50% of human and material costs in diagnostic gastroscopies (12).…”

Section: Discussionmentioning

confidence: 99%

“…A pulse oximetry may improve control of the respiratory function in patients under sedation and analgesia (13,14). Besides, the administration of oxygen before and during endoscopy reduces desaturation (12). That way monitorization with pulse oximetry as well as oxygen administration is recommended during all endoscopies with sedation (5).…”

Section: Discussionmentioning

confidence: 99%

“…Por otra parte, más alla de la discusión sobre la necesidad y el grado de sedación deseable en cada tipo de exploración, está claro que es necesario un mínimo de medios y unos conocimientos bási-cos para el manejo de la sedación con seguridad durante los procesos endoscópicos. De hecho, la sedación se estima que es responsable de entre el 30 y el 50% de los costes laborales y en equipamiento en las gastroscopias diagnósticas (12).…”

Section: Discussionunclassified

“…Un pulsioxímetro mejora el control de la función respiratoria en pacientes bajo sedación y analgesia (13,14). Así mismo, la administración de oxígeno suplementario antes y durante la endoscopia disminuye la magnitud de la desaturación (12). Por este motivo, se recomienda tanto la monitorización con pulsioximetría como la administración de oxígeno durante todas las endoscopias con sedación (5).…”

Section: Discussionunclassified

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Sedation at Endoscopic Units in Galicia: results of the "Sociedad Gallega de Patología Digestiva" inquiry

Cubiella

Seco

Piudo

et al. 2005

Rev. esp. enferm. dig.

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Aim: to evaluate the human and material resources available for sedation, and the usual manner of handling them at endoscopic units in Galicia.Methods: a prospective and descriptive study based on the performance, distribution, and analysis of a clinical practice inquiry. We requested information about endoscopies performed, available means for sedation, sedation monitoring, and level of sedation used in each procedure.Results: our inquiry was answered by twenty endoscopic units (thirteen were in public hospitals, and eleven performed complex procedures). Of these units, 80% had a pulse oximeter, 42% had continuous electrocardiography, 40% had a defibrillator, and 45% had a recovery area. The drug most commonly used in gastroscopies was midazolam (76%), and the combination midazolammeperidine was most frequent in both colonoscopies (72%) and ERCPs (60%). An anesthesiologist was usually available for certain procedures in 15% of units, and as an exception in 65%. Of those inquired, 35% wished to have a full-time anesthesiologist in the unit, 25% wished to have an anesthetist only for certain procedures, and 35% on an exceptional basis. Finally, endoscopists considered that 83% of therapeutical gastroscopies, 87% of therapeutical colonoscopies, 98% of ERCPs, 95% of enteroscopies, and 98% of echoendoscopies deserved sedation.Conclusions: although endoscopists consider that endoscopic procedures should benefit from sedation in a high proportion, the available resources to safely monitor patients are inadequate in some units.

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The Virtues of Transnasal Unsedated Upper Gastrointestinal Endoscopy

2006

Curr Gastroenterol Rep

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Struggling toward easier endoscopy

Cited by 29 publications

References 65 publications

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

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

Sedation at Endoscopic Units in Galicia: results of the "Sociedad Gallega de Patología Digestiva" inquiry

The Virtues of Transnasal Unsedated Upper Gastrointestinal Endoscopy

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