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Comparison of thin versus standard esophagogastroduodenoscopy
Thad Wilkins1, Albert Brewster, Jonathon Lammers
1Department of Family Practice, Malcolm Grow Medical Center, Andrews Air Force Basse, Marylannd, USA. twilkins@mail.mcg.edu
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 ultrathin EGD with significantly shorter recovery time and less overall anxiety than with the conventional 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.