Oral medications for upper gastrointestinal endoscopy using a small diameter endoscope

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Pharmacology

Background:

• Small diameter endoscopes offer potential advantages in patient comfort.
• Optimizing patient tolerance for endoscopic procedures is crucial for compliance and diagnostic yield.
• Topical anesthesia alone may not fully alleviate discomfort during upper endoscopy.

Purpose of the Study:

• To evaluate the efficacy of limited oral premedication in enhancing patient tolerance for small diameter endoscopes.
• To compare the tolerance of oral placebo, diphenhydramine, acetaminophen, and a combination thereof, alongside topical anesthesia.

Main Methods:

• Double-blinded, randomized prospective study design.
• Patients received topical Cetacaine and underwent upper endoscopy with a 7.9-mm fiberscope.
• Intervention groups received oral placebo, diphenhydramine (100 mg), acetaminophen (1000 mg), or both, 30-60 minutes prior to the procedure.

Main Results:

• The combination of acetaminophen (1000 mg) and diphenhydramine (100 mg) significantly improved patient tolerance compared to topical anesthetic alone.
• Oral premedications provided a slight additional improvement in tolerance.
• Obvious sedation was infrequent, and gag response to topical anesthesia was a significant predictor of overall tolerance.

Conclusions:

• Small diameter endoscopes are well-tolerated for diagnostic upper endoscopy.
• Oral premedication, particularly the combination of acetaminophen and diphenhydramine, offers a modest but significant improvement in patient tolerance.
• Minimizing gag response may be key to enhancing patient experience during endoscopy.