Mindfulness-based controlled breathing and the effect on performing a transnasal endoscopy: a quasi-experimental...

Transnasal endoscopy is the traditional modality of choice to evaluate the upper gastrointestinal tract, and patient anxiety and the unpleasantness of medical procedures remain a major problem in clinical practice. In this study, we examined whether mindful breathing can improve patients' wellbeing before nasal endoscopy.

This prospective, non-randomized controlled trial was conducted between January and March 2024 in the international outpatient endoscopy unit of Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital). A total of 249 adult patients scheduled for transnasal esophagogastroduodenoscopy (EGD) were enrolled. Participants were allocated to either the intervention group or the control group based on their order of arrival and personal preference. The intervention group comprised 124 patients who received a structured mindful breathing protocol, while the control group consisted of 125 patients undergoing standard care without additional breathing guidance. The intervention included pre-procedural instruction, directed breathing before and during the procedure with ongoing coaching. Primary outcome was pain intensity, measured using the Numeric Rating Scale (NRS, 0-10) at three time points: pre-procedure, intra-procedure, and post-procedure. Secondary outcomes included the severity of nausea and vomiting, categorized into four grades, and subjective wellbeing, assessed using a four-point Likert scale. All assessments were recorded by independent observers blinded to group allocation.

The statistical results showed significant difference in both groups. In the intervention group, after practicing mindful breathing, participants' mean pain level was significantly lower than before they practiced it (2.00 ± 1.05 versus 2.67 ± 1.46, with statistical significance at P < 0.001), with a greater percentage experiencing only minor discomfort (95.97% versus 84.80%, P = 0.005). The intervention group also showed decreased nausea and vomiting symptoms (1.13 ± 0.53 versus 1.34 ± 0.72, P = 0.01), with a higher number of cases rated as mild (93.55% versus 76.80%, P < 0.001). Regarding patient comfort, the mindfulness group scored consistently better both prior to (3.01 ± 0.49 vs. 2.77 ± 0.65, P < 0.001), (3.03 ± 0.48 vs. 2.69 ± 0.59, P < 0.001), but not following examination (P = 0.076). The correlations persisted with adjustment of potential confounders in multiple regression analysis.

Mindfulness breathing correlates to a significant decrease of procedure-related pain, particularly in the reduction of pain and GI discomfort with transnasal endoscopy. Such a finding is evidenced-cost-effective technique is a promising method to improve patients' acceptance, and it may need to be adopted into routine practice by the endoscopic nurses.