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Unsedated upper endoscopy in children
Phyllis R Bishop1, Michael J Nowicki, Warren L May
1Division of Pediatric Gastroenterology and Nutrition, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
Insights
Unsedated esophagogastroduodenoscopy (EGD) is safe and effective in children, reducing procedure time. Most children would choose no sedation for future EGDs, showing good tolerance.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
Background:
- Esophagogastroduodenoscopy (EGD) is crucial for diagnosing pediatric GI disorders.
- Sedation during EGD in children carries cardiopulmonary risks.
- Unsedated EGD in children lacks sufficient study.
Purpose of the Study:
- To assess the safety, efficacy, and feasibility of unsedated EGD in children.
- To compare outcomes between sedated and unsedated EGD in pediatric patients.
Main Methods:
- Children were offered a choice between sedation or no sedation for EGD.
- Pain and anxiety were assessed using validated scales before and after the procedure.
- Procedure preparation, EGD, and recovery times were recorded.
Main Results:
- EGD completion rates were similar: 96.3% for sedated and 95.2% for unsedated.
- Children choosing sedation had higher pre-procedure anxiety.
- Unsedated EGD significantly reduced total procedure time.
- 80% of children would opt for unsedated EGD again.
Conclusions:
- Unsedated EGD is a safe and successful option for motivated children.
- It offers reduced procedure time and good patient tolerance.
- Unsedated EGD should be considered a viable alternative.
Background:
EGD is essential to the investigation and treatment of GI disorders in children. Although safe, EGD has the potential for complications, in particular cardiopulmonary abnormalities associated with intravenous sedation. EGD is often performed in adults without sedation. Unsedated EGD is occasionally performed in children but has not been subjected to study. This study assessed the safety, efficacy, and feasibility of unsedated EGD in children.
Methods:
Selected, highly motivated children requiring EGD were offered the choice of sedation or no sedation for the procedure. Children recorded scores for pain (face scale) and anxiety (vertical visual analogue scale) before and after EGD. In addition, the times required to prepare the patient, perform the EGD, and recover the patient were recorded.
Results:
There was no difference in age, gender, or pre-EGD pain scores between children selecting sedation or no sedation. However, children selecting sedation had significantly higher pre-EGD anxiety scores than those who chose no sedation. Successful completion of EGD was similar for sedated (96.3%) and unsedated (95.2%) children. Post-EGD scores for anxiety were significantly decreased in those receiving sedation and unchanged in children who received no sedation. There was no significant change in post-EGD pain score in either group. Nearly 80% of children undergoing unsedated EGD would elect to forego sedation if EGD was needed again. Total procedure time was significantly longer in sedated versus unsedated children, reflecting longer preparation and recovery.
Conclusions:
Unsedated EGD can be performed safely and successfully in children with good patient tolerance. There was a significant decrease in total procedure time for children who have unsedated EGD. Unsedated EGD should be considered a viable option for motivated children.