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Predicting which patients can undergo upper endoscopy comfortably without conscious sedation
Neena Abraham1, Alan Barkun, Martin Larocque
1The Division of Gastroenterology of the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Gastrointestinal Endoscopy
|July 30, 2002
Summary
Unsedated diagnostic upper endoscopy is feasible but only moderately successful. Advancing age and decreased pharyngeal sensitivity predict a comfortable, technically adequate procedure, potentially improving patient safety and reducing costs.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Patient Safety
Background:
- Conscious sedation in diagnostic endoscopy presents challenges in patient safety and cost-effectiveness.
- Identifying predictors for successful unsedated procedures is crucial for optimizing patient care.
Purpose of the Study:
- To identify and validate independent predictors of a comfortable and technically adequate unsedated diagnostic upper endoscopy in Canadian patients.
Main Methods:
- Prospective enrollment of patients undergoing diagnostic upper endoscopy.
- Data collection included demographics, anxiety levels, prior endoscopy experience, pharyngeal sensitivity, and procedural outcomes.
- Statistical analyses (univariate and multivariate) were used to determine predictors of a satisfactory unsedated endoscopy, with validation in a separate cohort.
Main Results:
- The overall rate of satisfactory unsedated upper endoscopy was modest (59.5% in 336 patients).
- Independent predictors for a satisfactory procedure included advancing age (OR 1.2) and decreased pharyngeal sensitivity (OR 0.5).
- While technically adequate in 97%, only 61% reported a comfortable experience.
Conclusions:
- A significant proportion of patients can undergo unsedated upper endoscopy, but comfort levels are variable.
- Older patients with reduced pharyngeal sensitivity are more likely to have a successful unsedated procedure.
- Further research is needed to assess generalizability and cost-effectiveness in different populations.