Journal of Gastroenterology

, Volume 43, Issue 1, pp 38–44 | Cite as

Autonomic nervous function in upper gastrointestinal endoscopy: A prospective randomized comparison between transnasal and oral procedures

  • Akihiro Mori
  • Noritsugu Ohashi
  • Hideharu Tatebe
  • Takako Maruyama
  • Hiroshi Inoue
  • Shoudou Takegoshi
  • Toshiharu Kato
  • Masataka Okuno


Background. Transnasal esophagogastroduodenoscopy (EGD) using an ultrathin endoscope is less stressful to the cardiovascular system with less elevation of systolic blood pressure (BP) than oral procedures. To elucidate the mechanism of such beneficial cardiovascular responses, we performed a prospective patient-centered randomized study in which BP and pulse rate (P), as well as autonomic nervous functions, were estimated during transnasal EGD compared with those in oral procedures using the same ultrathin endoscope. Methods. The study involved 781 patients, among whom 55 and 56 cases were assigned to transnasal and oral EGD groups, respectively. The autonomic nervous responses were determined employing power spectral analysis (PSA) of heart-rate variations on electrocardiogram. PSA data were based on two peaks in lowfrequency (LF) and high-frequency (HF) ranges. HF power and the ratio of LF power/HF power represented parasympathetic and sympathetic nervous activities, respectively. Results. Our study confirmed the lesser elevation of BP and P in patients undergoing transnasal EGD than in those undergoing oral procedures. PSA revealed a lower increase in LH power/HF power in transnasal EGD than in oral EGD. However, both endoscopic procedures equally suppressed HF power. Significant correlations were found between the parameters of cardiovascular response (P and BP) and autonomic functions (LF power/HF power ratio and HF power). Conclusions. This is the first study demonstrating less sympathetic stimulation in patients undergoing transnasal EGD, leading to lesser elevation of BP and P.

Key words

transnasal endoscopy autonomic nervous function blood pressure pulse rate cardiovascular stress 


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  1. 1.
    Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, de Garmo P, Fleischer DE. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc 2007;66:27–34.PubMedCrossRefGoogle Scholar
  2. 2.
    Gandi S, Saidi F, Patel K, Johnstone B, Jaeger J, Shine D. Cardiovascular complications after GI endoscopy: occurrence and risks in a large hospital system. Gastrointest Endosc 2004;60:679–85.CrossRefGoogle Scholar
  3. 3.
    Yazawa K, Adachi W, Koide N, Watanabe H, Koike S, Hanazaki K. Changes in cardiopulmonary parameters during upper gastrointestinal endoscopy in patients with heart disease: towards safer endoscopy. Endoscopy 2000;32:287–93.PubMedCrossRefGoogle Scholar
  4. 4.
    Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB. Results from the American Society for Gastrointestinal Endoscopy/US Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 1991;37:421–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Saeian K. Unsedated transnasal endoscopy: a safe and less costly alternative. Curr Gastroenterol Rep 2002;4:213–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Dean R, Dua K, Massey B, Berger W, Hogan WJ, Shaker R. A comparative study of unsedated transnasal esophagogastroduodenoscopy and conventional EGD. Gastrointest Endosc 1996;44:422–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Dumortier J, Napoleon B, Hedelius F, Pellissier PE, Leprince E, Pujol B, et al. Unsedated transnasal EGD in daily practice: results with 1100 consecutive patients. Gastrointest Endosc 2003;57:198–204.PubMedCrossRefGoogle Scholar
  8. 8.
    Preiss C, Charton JP, Schumacher B, Neuhaus H. A randomized trial of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) versus peroral small-caliber EGD versus conventional EGD. Endoscopy 2003;35:641–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Yagi J, Adachi K, Arima N, Tanaka S, Ose T, Azumi T, et al. A prospective randomized comparative study on the safety and tolerability of transnasal esophagogastroduodenoscopy. Endoscopy 2005;37:1226–31.PubMedCrossRefGoogle Scholar
  10. 10.
    Mori A, Fushimi N, Asano, T, Maruyama T, Ohashi N, Okumura S, et al. Cardiovascular tolerance in unsedated upper gastrointestinal endoscopy: prospective randomized comparison between transnasal and conventional oral procedures. Dig Endosc 2006;18:282–7.CrossRefGoogle Scholar
  11. 11.
    Hayashi T, Nomura M, Honda H, Tezuka K, Torisu R, Takeuchi Y, et al. Evaluation of autonomic nervous function during upper gastrointestinal endoscopy using heart rate variability. J Gastroenterol 2000;35:815–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Saijyo T, Nomura M, Nakaya Y, Saito K, Kondo Y, Yukinaka M, et al. Assessment of autonomic nervous activity during gastrointestinal endoscopy: analysis of blood pressure variability by tonometry. J Gastroenterol Hepatol 1998;13:816–20.PubMedGoogle Scholar
  13. 13.
    Tezuka K, Nomura M, Saito K, Takeuchi Y, Torisu R, Yano M, et al. Changes in autonomic nervous activity during colonoscopy using spectral analysis of heart rate variability. Dig Endosc 2000;12:155–61.CrossRefGoogle Scholar
  14. 14.
    Ochi Y, Nomura M, Okamura S, Yano M, Saito K, Nakaya Y, et al. Changes in autonomic nervous activity during endoscopic retrograde cholangiopancreatography: a possible factor in cardiac complications. J Gastroenterol Hepatol 2002;17:1021–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Bradley C. Designing medical and educational intervention studies. Diabetes Care 1993;16:509–18.PubMedCrossRefGoogle Scholar
  16. 16.
    Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P, et al. Power spectral analysis of heart rate and arterial pressure variability as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res 1986;59:178–93.PubMedGoogle Scholar
  17. 17.
    Hayano J, Sakakibara Y, Yamada A, Yamada M, Mukai S, Fujinami T, et al. Accuracy of assessment of cardiac vagal tone by heart rate variability in normal subjects. Am J Cardiol 1991;67:199–204.PubMedCrossRefGoogle Scholar
  18. 18.
    Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Circulation 1996;93:1043–65.Google Scholar
  19. 19.
    Lieberman DA, Wuerker CK, Katon RM. Cardiopulmonary risk of esophagogastroduodenoscopy. Role of endoscope diameter and systemic sedation. Gastroenterology 1985;88:468–72.PubMedGoogle Scholar
  20. 20.
    Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987;59:295–9.PubMedCrossRefGoogle Scholar
  21. 21.
    King BD, Harris LC, Greifenstein FE, Elder JD, Drippus RD. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology 1951;12:556–66.PubMedCrossRefGoogle Scholar
  22. 22.
    Myerburg RJ, Kessler KM, Mallon SM, Cox MM, deMarchena E, Interian A,et al. Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med 1992;326:1451–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Lown B, Verrier RL. Neural activity and ventricular fibrillation. N Engl J Med 1976;294:1165–70.PubMedCrossRefGoogle Scholar
  24. 24.
    Vanoli E, De Ferrari GM, Stramba-Badiale M, Hull SS, Foreman RD, Schwartz PJ. Vagal stimulation and prevention of sudden death in conscious dogs with a healed myocardial infarction. Circ Res 1991;68:1471–81.PubMedGoogle Scholar
  25. 25.
    Mori A, Asano T, Maruyama T, Ohashi N, Inoue H, Takekoshi S, et al. Transnasal ERCP/ENBD using an ultrathin esophagogastroduodenoscope. J Gastroenterol 2006;41:1237–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2008

Authors and Affiliations

  • Akihiro Mori
    • 1
  • Noritsugu Ohashi
    • 1
  • Hideharu Tatebe
    • 1
  • Takako Maruyama
    • 1
  • Hiroshi Inoue
    • 1
  • Shoudou Takegoshi
    • 1
  • Toshiharu Kato
    • 2
  • Masataka Okuno
    • 1
  1. 1.Department of GastroenterologyInuyama Chuo HospitalGoromuru, Inuyama, AichiJapan
  2. 2.Department of Laboratory MedicineInuyama Chuo HospitalAichiJapan

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