Brief Article
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World J Gastrointest Endosc. Jul 16, 2013; 5(7): 346-351
Published online Jul 16, 2013. doi: 10.4253/wjge.v5.i7.346
Ultrathin endoscope flexibility can predict discomfort associated with unsedated transnasal esophagogastroduodenoscopy
Satoshi Ono, Keiko Niimi, Mitsuhiro Fujishiro, Tomoko Nakao, Kazushi Suzuki, Yumiko Ohike, Shinya Kodashima, Nobutake Yamamichi, Tsutomu Yamazaki, Kazuhiko Koike
Satoshi Ono, Tomoko Nakao, Kazushi Suzuki, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
Keiko Niimi, Mitsuhiro Fujishiro, Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
Satoshi Ono, Keiko Niimi, Mitsuhiro Fujishiro, Shinya Kodashima, Kazuhiko Koike, Nobutake Yamamichi, Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
Author contributions: Ono S, Niimi K and Fujishiro M designed the study, protocol and analyzed the data; Ono S made drafting of the article; Niimi K, Fujishiro M, Nakao T, Suzuki K, Ohike Y and Yamamichi N made critical revision of the article for important intellectual content; Yamazaki T and Koike K made final approval of the article.
Correspondence to: Satoshi Ono, MD, PhD, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. satoshi-tky@umin.ac.jp
Telephone: +81-3-38155411 Fax: +81-3-58008806
Received: March 15, 2013
Revised: April 27, 2013
Accepted: June 18, 2013
Published online: July 16, 2013
Abstract

AIM: To evaluate the effects of choice of insertion route and ultrathin endoscope types.

METHODS: This prospective study (January-June 2012) included 882 consecutive patients who underwent annual health checkups. Transnasal esophagogastroduodenoscopy (EGD) was performed in 503 patients and transoral EGD in 235 patients using six types of ultrathin endoscopes. Patients were given a choice of insertion route, either transoral or transnasal, prior to EGD examination. For transoral insertion, the endoscope was equipped with a thin-type mouthpiece and tongue depressor. Conscious sedation was not used for any patient. EGD-associated discomfort was assessed using a visual analog scale (VAS; no discomfort 0- maximum discomfort 10).

RESULTS: Rates of preference for transnasal insertion were significantly higher in male (male/female 299/204 vs 118/117) and younger patients (56.8 ± 11.2 years vs 61.3 ± 13.0 years), although no significant difference was found in VAS scores between transoral and transnasal insertion (3.9 ± 2.3 vs 4.1 ± 2.5). Multivariate analysis revealed that gender, age, operator, and endoscope were independent significant predictors of VAS for transnasal insertion, although gender, age, and endoscope were those for transoral insertion. Further analysis revealed only the endoscopic flexibility index (EFI) as an independent significant predictor of VAS for transnasal insertion. Both EFI and tip diameter were independent significant predictors of VAS for transoral insertion.

CONCLUSION: Flexibility of ultrathin endoscopes can be a predictor of EGD-associated discomfort, especially in transnasal insertion.

Keywords: Esophagogastroduodenoscopy, Ultrathin endoscope, Visual analog scale, Discomfort, Surveillance

Core tip: To evaluate the effects of choice of insertion route and ultrathin endoscope types for unsedated surveillance esophagogastroduodenoscopy (EGD), this prospective study was conducted including 882 consecutive patients who underwent annual health checkup using six types of ultrathin endoscopes in a single institute. EGD-associated discomfort was assessed using a visual analog scale (VAS) by patients themselves. Statistical analysis of VAS revealed the following two points; Transnasal insertion of ultrathin endoscopy for unsedated EGD can be preferable for younger males rather than elder females. Flexibility of ultrathin endoscopes can be a reliable predictor of reduction in transnasal EGD-associated discomfort rather than thinness of tip.