Skip to main content
SpringerLink
Log in

Unsedated transnasal upper gastrointestinal endoscopy has favorable diagnostic effectiveness, cardiopulmonary safety, and patient satisfaction compared with conventional or sedated endoscopy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

To assess the diagnostic effectiveness, cardiopulmonary safety, and patient comfort of transnasal endoscopy (TNE), compared with conventional endoscopy (CES) and sedated endoscopy (SES), and to compare procedural risks and patient satisfaction/preference.

Methods

In this prospective, randomized, and controlled protocol, eligible patients (n = 397) in an outpatient clinic were randomized to CES (n = 133), SES (n = 134), or unsedated TNE (n = 130) due to upper gastrointestinal (GI) complaints. Patients were continuously monitored for systolic/diastolic blood pressure (SBP/DBP), pulse rate (PR), and SpO2 throughout the endoscopy. All subjects (n = 392) completing their assigned endoscopy were asked to evaluate endoscopy satisfaction, pain, and nausea/vomiting on visual analog scales. Patient preference for the assigned endoscopy was assessed against previous endoscopy experience or by willingness to repeat the assigned endoscopy.

Results

Endoscopic outcomes for the esophagus, stomach, and duodenum were comparable among the three groups. SBP/DBP and PR were more stable in patients undergoing TNE than in those undergoing CES or SES, while SpO2 remained stable and above 95 % among all three groups. Patients were more satisfied with TNE than with CES and experienced less pain and nausea/vomiting. Patients exhibited a high preference for SES, whereas 67.6 % of patients who previously underwent SES and were randomly assigned to TNE were willing to undergo TNE again.

Conclusions

TNE has comparable diagnostic effectiveness to CES and SES, but is less stressful on cardiopulmonary function, indicating that TNE is a more comfortable, preferred, and cost-effective endoscopic technique than CES and SES.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Carey EJ, Sorbi D (2004) Unsedated endoscopy. Gastrointest Endosc Clin N Am 14:369–383

    Article  PubMed  Google Scholar 

  2. Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, Mallery JS, Raddawi HM, Vargo JJ II, Waring JP, Fanelli RD, Wheeler-Harbough J, American Society for Gastrointestinal Endoscopy (2002) Complications of upper GI endoscopy. Gastrointest Endosc 55:784–793

    Article  PubMed  Google Scholar 

  3. Iqbal CW, Askegard-Giesmann JR, Pham TH, Ishitani MB, Moir CR (2008) Pediatric endoscopic injuries: incidence, management, and outcomes. J Pediatr Surg 43:911–915

    Article  PubMed  Google Scholar 

  4. Meining A, Semmler V, Kassem AM, Sander R, Frankenberger U, Burzin M, Reichenberger J, Bajbouj M, Prinz C, Schmid RM (2007) The effect of sedation on the quality of upper gastrointestinal endoscopy: an investigator-blinded, randomized study comparing propofol with midazolam. Endoscopy 39:345–349

    Article  PubMed  CAS  Google Scholar 

  5. Cohen LB (2008) Patient monitoring during gastrointestinal endoscopy: why, when, and how? Gastrointest Endosc Clin N Am 18:651–663

    Article  PubMed  Google Scholar 

  6. Abraham N, Barkun A, Larocque M, Fallone C, Mayrand S, Baffis V, Cohen A, Daly D, Daoud H, Joseph L (2002) Predicting which patients can undergo upper endoscopy comfortably without conscious sedation. Gastrointest Endosc 56:180–189

    Article  PubMed  Google Scholar 

  7. Douma KF, Bleiker EM, Aaronson NK, Cats A, Gerritsma MA, Gundy CM, Vasen HF (2010) Long-term compliance with endoscopic surveillance for familial adenomatous polyposis. Colorectal Dis 12:1198–1207

    Article  PubMed  CAS  Google Scholar 

  8. Feld AD (2008) Endoscopic sedation: medicolegal considerations. Gastrointest Endosc Clin N Am 18:783–788

    Article  PubMed  Google Scholar 

  9. Hazeldine S, Fritschi L, Forbes G (2010) Predicting patient tolerance of endoscopy with conscious sedation. Scand J Gastroenterol 45:1248–1254

    Article  PubMed  Google Scholar 

  10. Abraham NS, Fallone CA, Mayrand S, Huang J, Wieczorek P, Barkun AN (2004) Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy: a Canadian randomized controlled cost-outcome study. Am J Gastroenterol 99:1692–1699

    Article  PubMed  Google Scholar 

  11. Akyuz U, Pata C, Senkal V, Erzin Y (2010) Is propofol sedation with midazolam induction safe during endoscopic procedures without anesthesiologist? Hepatogastroenterology 57:685–687

    PubMed  CAS  Google Scholar 

  12. Riphaus A, Lechowicz I, Frenz MB, Wehrmann T (2009) Propofol sedation for upper gastrointestinal endoscopy in patients with liver cirrhosis as an alternative to midazolam to avoid acute deterioration of minimal encephalopathy: a randomized, controlled study. Scand J Gastroenterol 44:1244–1251

    Article  PubMed  CAS  Google Scholar 

  13. Kerker A, Hardt C, Schlief HE, Dumoulin FL (2010) Combined sedation with midazolam/propofol for gastrointestinal endoscopy in elderly patients. BMC Gastroenterol 10:11

    Article  PubMed  Google Scholar 

  14. Stroppa I, Grasso E, Paoluzi OA, Razzini C, Tosti C, Andrei F, Biancone L, Palmieri G, Romeo F, Pallone F (2008) Unsedated transnasal versus transoral sedated upper gastrointestinal endoscopy: a one-series prospective study on safety and patient acceptability. Dig Liver Dis 40:767–775

    Article  PubMed  CAS  Google Scholar 

  15. Yuki M, Amano Y, Komazawa Y, Fukuhara H, Shizuku T, Yamamoto S, Kinoshita Y (2009) Unsedated transnasal small-caliber esophagogastroduodenoscopy in elderly and bedridden patients. World J Gastroenterol 15:5586–5591

    Article  PubMed  Google Scholar 

  16. Dean R, Dua K, Massey B, Berger W, Hogan WJ, Shaker R (1996) A comparative study of unsedated transnasal esophagogastroduodenoscopy and conventional EGD. Gastrointest Endosc 44:422–424

    Article  PubMed  CAS  Google Scholar 

  17. Yagi J, Adachi K, Arima N, Tanaka S, Ose T, Azumi T, Sasaki H, Sato M, Kinoshita Y (2005) A prospective randomized comparative study on the safety and tolerability of transnasal esophagogastroduodenoscopy. Endoscopy 37:1226–1231

    Article  PubMed  CAS  Google Scholar 

  18. Mori A, Ohashi N, Tatebe H, Maruyama T, Inoue H, Takegoshi S, Kato T, Okuno M (2008) Autonomic nervous function in upper gastrointestinal endoscopy: a prospective randomized comparison between transnasal and oral procedures. J Gastroenterol 43:38–44

    Article  PubMed  Google Scholar 

  19. Kim CY, O’Rourke RW, Chang EY, Jobe BA (2006) Unsedated small-caliber upper endoscopy: an emerging diagnostic and therapeutic technology. Surg Innov 13:31–39

    Article  PubMed  Google Scholar 

  20. Horiuchi A, Nakayama Y, Hidaka N, Ichise Y, Kajiyama M, Tanaka N (2009) Prospective comparison between sedated high-definition oral and unsedated ultrathin transnasal esophagogastroduodenoscopy in the same subjects: pilot study. Dig Endosc 21:24–28

    Article  PubMed  Google Scholar 

  21. Dumortier J, Josso C, Roman S, Fumex F, Lepilliez V, Prost B, Lot M, Guillaud O, Petit-Laurent F, Lapalus MG, Ponchon T (2007) Prospective evaluation of a new ultrathin one-plane bending videoendoscope for transnasal EGD: a comparative study on performance and tolerance. Gastrointest Endosc 66:13–19

    Article  PubMed  Google Scholar 

  22. Tatsumi Y, Harada A, Matsumoto T, Tani T, Nishida H (2009) Current status and evaluation of transnasal esophagogastroduodenoscopy. Dig Endosc 21:141–146

    Article  PubMed  Google Scholar 

  23. Cho S, Arya N, Swan K, Cirocco M, Kandel G, Kortan P, Marcon N (2008) Unsedated transnasal endoscopy: a Canadian experience in daily practice. Can J Gastroenterol. 22(3):243–246

    PubMed  CAS  Google Scholar 

  24. Murata A, Akahoshi K, Sumida Y, Yamamoto H, Nakamura K, Nawata H (2007) Prospective randomized trial of transnasal versus peroral endoscopy using an ultrathin videoendoscope in unsedated patients. J Gastroenterol Hepatol 22:482–485

    Article  PubMed  Google Scholar 

  25. Dua KS, Ruan E, Shaker R (1996) Transnasal pharyngoesophagogastroduodenoscopy (T-PEGD) in a patient with acute upper gastrointestinal bleeding. Endoscopy 28:530

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

Zheng-Lin Ai, Chun-Hui Lan, Li-Lin Fan, Li Lan, Yan Cao, Ping Li, Ou Song, Dong-Feng Chen have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Daping Hospital, The Third Military Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China

    Zheng-Lin Ai, Chun-Hui Lan, Li-Lin Fan, Li Lan, Yan Cao, Ping Li, Ou Song & Dong-Feng Chen

Authors
  1. Zheng-Lin Ai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chun-Hui Lan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li-Lin Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li Lan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yan Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ou Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dong-Feng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chun-Hui Lan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ai, ZL., Lan, CH., Fan, LL. et al. Unsedated transnasal upper gastrointestinal endoscopy has favorable diagnostic effectiveness, cardiopulmonary safety, and patient satisfaction compared with conventional or sedated endoscopy. Surg Endosc 26, 3565–3572 (2012). https://doi.org/10.1007/s00464-012-2367-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2367-4

Keywords

Search

Navigation