Successful completion of upper gastrointestinal endoscopy: A retrospective comparative study on patients who had endoscopy with sedation and without sedation

Abstract

Introduction: Sedation of patients before esophagoduodenoscopy (EGD) is common practice. It is expensive, increases the time required to perform the procedure and increases risks of complications. We have set out to determine if sedation improves EGD completion rates. Methods: 1539 EGDs were performed in the UK by an experienced endoscopist. The age, sex, premedication and completion data made at each procedure were recorded. A completed procedure was defined by the ability of the endoscopist to reach the second part of the duodenum. We measured the difference in the completion rates of EGD between sedated and non sedated patients. Results: The completion rate for all procedures was 96.6%. 97.8% of procedures were complete in non sedated patients vs. 94.7% in sedated patients (p = 0.001). Male patients were more likely to have the EGD without sedation, as were those over the age of 65. There were no significant differences in the completion rates of EGD between patients who received IV sedation plus topical local anesthesia and those who received IV sedation alone. Conclusion: The effect of sedation on EGD completion rates is previously undocumented. In order to reduce numbers of failed procedures and prevent exposing patients to the risks of sedation, we suggest these patients should be targeted for more intense pre-procedure counseling. Adequate explanation and reassurance may reduce numbers of patients who request IV sedation by reducing anxiety and increasing expectations of comfort. Reducing numbers of sedated patients may also result in a faster, more cost effective service. (J Dig Endosc 2013;4(2):33-38)

Intolerance of Uncertainty and Anxiety-Related Dispositions Predict Pain During Upper Endoscopy

“…According to Carleton (2016), IU reflects a more basic fear of the unknown “caused by the perceived absence of information at any level of consciousness ” (p. 5, italics added). This definition is consistent with evidence showing that “first-timers,” lacking experiential information about the procedure, tend to feel greater anxiety than “repeaters” (Davies and Roy, 2013) and with studies supporting the effectiveness of psychological preparation, in which the patients are acquainted with the physical sensations that may arise during EGD (Maguire et al, 2004; García Sierra et al, 2013; Behrouzian et al, 2017; Liu et al, 2018; Ghonaem and Ibrahim, 2019).…”

“…There is a need to prioritize patients who are at greater risk of experiencing clinically relevant anxiety, targeting those to be psychologically prepared according to their needs and personality characteristics. Female gender, younger age, and no previous endoscopy experience are known risk factors for pre-procedural anxiety and low EGD tolerability (Davies and Roy, 2013; Lee et al, 2014; Gürbulak et al, 2018; Sayilan and Oztekin, 2018). However, the psychological characteristics that make these groups more difficult to examine are still unclear, and identifying which patients might tolerate digestive endoscopy less well remains challenging (Hazeldine et al, 2010; Bal et al, 2012).…”

Endoscopy audit over 10 years in a community hospital in Egypt

“…Davies et al reported an EGD completion rate of 94.7%. 16 A protocol for management of upper gastrointestinal bleeding was designed to be within the available resources of the hospital and all patients presenting with acute upper gastrointestinal bleeding have been assessed and managed by this since 2004. 17,18 The effectiveness of endoscopic therapy was monitored.…”

The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database

“…It is accepted that not all OGDs can be completed to D2 due to patient intolerance, stricture or previous gastric surgery 2 3. Nevertheless, successful completion of OGDs is a prerequisite for competency.…”