Comparison of thin versus standard esophagogastroduodenoscopy

Jeff T Wilkins, Albert Brewster, Jonathon Lammers

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVE: To compare the tolerance, feasibility, and safety of ultrathin esophagogastroduodenoscopy (EGD) in unsedated patients with conventional EGD in sedated patients. STUDY DESIGN: This was an unblinded, randomized controlled trial. POPULATION: Diagnostic EGD was performed on 72 adult outpatients at a US Air Force community hospital residency. Patients were randomized to either ultrathin or conventional EGD (n = 33 and 39, respectively). OUTCOMES MEASURED: Patients reported their tolerance of the procedure (pain, choking, gagging, and anxiety; scale 0-10), and the endoscopist reported the effectiveness of the procedure (successful intubation, reaching duodenum, retroflexion, and duration of examination and recovery) and safety (complications). RESULTS: No statistically significant difference was noted between the 2 groups in mean procedure time or pain during the procedure. Mean (± standard error) recovery time was approximately halved in the ultrathin group vs the conventional group (21.5 ± 2.3 min vs 55.4 ± 2.3 min, P < .0001). Although patients undergoing ultrathin EGD had higher mean gagging and choking scores, they had lower mean anxiety scores. Of 33 patients randomized to the unsedated ultrathin EGD procedure, 29 completed the protocol. The retroflexion maneuver was completed in 85% of patients in the ultrathin EGD group and 100% of patients in the conventional EGD group (P = .017). No statistically significant difference was noted between groups as to the likelihood of reaching the second portion of the duodenum (97% vs 100%). CONCLUSIONS: Most patients tolerate ultra-thin EGD with significantly shorter recovery time and less overall anxiety than with the conventioanl procedure. Techniques to reduce gagging and choking associated with ultrathin EGD may improve patient acceptance and tolerability. Adoption of ultrathin EGD by primary care physicians may decrease cost, time, and inconvenience while increasing access to EGD for many patients.

Original languageEnglish (US)
Pages (from-to)625-629
Number of pages5
JournalJournal of Family Practice
Volume51
Issue number7
StatePublished - Jul 22 2002

Fingerprint

Digestive System Endoscopy
Gagging
Airway Obstruction
Anxiety
Duodenum
Safety
Pain
Military Hospitals
Community Hospital
Primary Care Physicians
Internship and Residency
Intubation

Keywords

  • Conscious sedation
  • Endoscopy
  • Gastrointestinal
  • Randomized controlled trials

ASJC Scopus subject areas

  • Family Practice

Cite this

Comparison of thin versus standard esophagogastroduodenoscopy. / Wilkins, Jeff T; Brewster, Albert; Lammers, Jonathon.

In: Journal of Family Practice, Vol. 51, No. 7, 22.07.2002, p. 625-629.

Research output: Contribution to journalArticle

Wilkins, JT, Brewster, A & Lammers, J 2002, 'Comparison of thin versus standard esophagogastroduodenoscopy', Journal of Family Practice, vol. 51, no. 7, pp. 625-629.
Wilkins, Jeff T ; Brewster, Albert ; Lammers, Jonathon. / Comparison of thin versus standard esophagogastroduodenoscopy. In: Journal of Family Practice. 2002 ; Vol. 51, No. 7. pp. 625-629.
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AB - OBJECTIVE: To compare the tolerance, feasibility, and safety of ultrathin esophagogastroduodenoscopy (EGD) in unsedated patients with conventional EGD in sedated patients. STUDY DESIGN: This was an unblinded, randomized controlled trial. POPULATION: Diagnostic EGD was performed on 72 adult outpatients at a US Air Force community hospital residency. Patients were randomized to either ultrathin or conventional EGD (n = 33 and 39, respectively). OUTCOMES MEASURED: Patients reported their tolerance of the procedure (pain, choking, gagging, and anxiety; scale 0-10), and the endoscopist reported the effectiveness of the procedure (successful intubation, reaching duodenum, retroflexion, and duration of examination and recovery) and safety (complications). RESULTS: No statistically significant difference was noted between the 2 groups in mean procedure time or pain during the procedure. Mean (± standard error) recovery time was approximately halved in the ultrathin group vs the conventional group (21.5 ± 2.3 min vs 55.4 ± 2.3 min, P < .0001). Although patients undergoing ultrathin EGD had higher mean gagging and choking scores, they had lower mean anxiety scores. Of 33 patients randomized to the unsedated ultrathin EGD procedure, 29 completed the protocol. The retroflexion maneuver was completed in 85% of patients in the ultrathin EGD group and 100% of patients in the conventional EGD group (P = .017). No statistically significant difference was noted between groups as to the likelihood of reaching the second portion of the duodenum (97% vs 100%). CONCLUSIONS: Most patients tolerate ultra-thin EGD with significantly shorter recovery time and less overall anxiety than with the conventioanl procedure. Techniques to reduce gagging and choking associated with ultrathin EGD may improve patient acceptance and tolerability. Adoption of ultrathin EGD by primary care physicians may decrease cost, time, and inconvenience while increasing access to EGD for many patients.

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