Clinical Research
Copyright ©The Author(s) 2004. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 15, 2004; 10(22): 3313-3317
Published online Nov 15, 2004. doi: 10.3748/wjg.v10.i22.3313
Upper gastrointestinal endoscopy: Are preparatory interventions or conscious sedation effective? A randomized trial
Lucio Trevisani, Sergio Sartori, Piergiorgio Gaudenzi, Giuseppe Gilli, Giancarlo Matarese, Sergio Gullini, Vincenzo Abbasciano
Lucio Trevisani, Sergio Sartori, Piergiorgio Gaudenzi, Giancarlo Matarese, Sergio Gullini, Vincenzo Abbasciano, Digestive Endoscopy Service, Department of Internal Medicine, S. Anna Hospital, Ferrara, Italy
Giuseppe Gilli, Health Physics Department, S. Anna Hospital, Ferrara, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Lucio Trevisani, Centro di Endoscopia Digestiva, Azienda Ospedaliera "Arcispedale S. Anna", C.so Giovecca 203, 44100 Ferrara, Italy. tvl@unife.it
Telephone: +1139-532-237558 Fax: +1139-532-236932
Received: February 20, 2004
Revised: April 4, 2004
Accepted: April 9, 2004
Published online: November 15, 2004
Abstract

AIM: The fears and concerns are associated with gastroscopy (EGD) decrease patient compliance. Conscious sedation (CS) and non-pharmacological interventions have been proposed to reduce anxiety and allow better execution of EGD. The aim of this study was to assess whether CS, supplementary information with a videotape, or presence of a relative during the examination could improve the tolerance to EGD.

METHODS: Two hundred and twenty-six outpatients (pts), scheduled for a first-time non-emergency EGD were randomly assigned to 4 groups: Co-group (62 pts): throat anaesthesia only; Mi-group (52 pts): CS with i.v. midazolam; Re-group (58 pts): presence of a relative throughout the procedure; Vi-group (54 pts): additional information with a videotape. Anxiety was measured using the "Spielberger State and Trait Anxiety Scales". The patients assessed the overall discomfort during the procedure on an 100-mm visual analogue scale, and their tolerance to EGD answering a questionnaire. The endoscopist evaluated the technical difficulty of the examination and the tolerance of the patients on an 100-mm visual analogue scale and answering a questionnaire.

RESULTS: Pre-endoscopy anxiety levels were higher in the Mi-group than in the other groups (P < 0.001). On the basis of the patients' evaluation, EGD was well tolerated by 80.7% of patients in Mi-group, 43.5% in Co-group, 58.6% in Re-group, and 50% in Vi-group (P < 0.01). The discomfort caused by EGD, evaluated by either the endoscopist or the patients, was lower in Mi-group than in the other groups. The discomfort was correlated with "age" (P < 0.001) and "groups of patients" (P < 0.05) in the patients' evaluation, and with "gender" (females tolerated better than males, P < 0.001) and "groups of patients" (P < 0.05) in the endoscopist's evaluation.

CONCLUSION: Conscious sedation can improve the tolerance to EGD. Male gender and young age are predictive factors of bad tolerance to the procedure.

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