Background and Study Aims: In an outpatient gastroenterological practice setting, highly effective diagnostic
procedures and patient satisfaction play an important role. Ultrathin endoscopy in
unsedated patients has been shown to be more cost-effective and time-efficient in
comparison with standard endoscopy. A prospective randomized study was carried out
in unsedated patients to compare performance, feasibility, safety, and patient tolerance
between ultrathin transnasal (UT), ultrathin oral (UO), and standard (SO) esophagogastroduodenoscopy
(EGD).Patients and Methods: A total of 200 of 600 eligible patients consented to participate in the study, and
were randomly assigned to undergo UT, UO, or SO. Patients reported their tolerance
of the procedure (anxiety, pain, gagging, and overall satisfaction; Likert scale 1-10),
and the endoscopists reported the effectiveness of the procedure (handling, picture
quality, and overall performance; Likert scale 1-10). Statistics were calculated using
the Kruskal-Wallis test.Results: After randomization, 65, 67, and 68 patients were allocated to the UT, UO, and SO
groups, respectively. Failure to achieve complete EGD by the intended route occurred
in 14 patients (22 %) in the UT group. Compared to the SO group, patients in the UT
and UO groups rated anxiety before the procedure as being more intense - median score
(10 % quantile estimate; 90 % quantile estimate): UT, 2.0 (1.0; 4.0); UO, 2.0 (1.0;
4.0); SO, 0.0 (0.0; 2.0); p < 0.0001), whereas SO patients experienced a higher level
of anxiety during the procedure (P < 0.0001). Pain during insertion of the endoscope was the least intense in the UO
group: UT, 2.0 (1.0; 5.0); UO, 1.0 (1.0; 3.0); SO, 2.0 (1.0; 4.0); P < 0.001). Gagging during insertion was more pronounced in the UO group: UT, 2.0 (1.0;
4.0); UO, 3.0 (1.0; 7.0); SO, 2.0 (1.0; 5.0); P < 0.01). The patients’ score for the overall assessment was better in the SO group
(P < 0.0001). The endoscopists’ overall assessment for ultrathin EGD was poorer than
for standard EGD: UT, 3.0 (2.0; 5.0); UO, 3.0 (2.0; 5.0); SO, 2.0 (1.0; 3.0); P < 0.0001).Conclusions: Ultrathin endoscopy through both the transnasal and oral routes has limited use in
routine outpatient practice. Techniques for reducing pain and gagging may improve
patient tolerance. Further technical improvements are needed to allow routine implementation.
References
BBirkner@t-oline.de
