Causative factors of discomfort in esophagogastroduodenoscopy: A large-scale cross-sectional study

Table 1 Participants’ demographics (n = 1715)

Possible factors relating to discomfort	Mean (SD)
Age	59 (11)
BMI	23.5 (3.6)
Height	163.1 (8.8)
Possible factors relating to discomfort number (%)
Age
≤ 39	80 (4.7)
40-49	308 (18.0)
50-59	431 (25.1)
60-69	610 (35.6)
≥ 70	286 (16.7)
Male sex	950 (55%)
BMI ≥ 25	503 (29.3)
Height
< 150 cm	114 (6.7)
150-160 cm	546 (31.8)
160-170 cm	644 (37.6)
≥ 170 cm	411 (24.0)
Smoking status
Non-smoker	988 (57.6)
Past-smoker	487 (28.4)
Current-smoker	240 (14.0)
Alcohol consumption
Non-drinker	761 (44.4)
Normal drinker	812 (47.4)
Heavy-drinker	142 (8.3)
History of endoscopy	1602 (93.4)
History of gastrectomy	30 (1.8)
Butylscopolamine administration	511 (29.8)
Biopsy performed	49 (2.9)
Lugol’s solution use	7 (0.4)
Small diameter endoscope	1657 (96.6)
Hiatal hernia	775 (45.2)
Sedative
None	774 (45.1)
Pethidine	797 (46.5)
Midazolam	19 (1.1)
Pethidine and midazolam	125 (7.3)

BMI: Body mass index.

Table 2 Discomfort for each factor in the group without sedation (n = 774) and univariate analysis results

Discomfort score value median (quartile ranges)			Proportion of high discomfort (score ≥ 6)
Age
≤ 39	6 (4-8)	P < 0.001	60.5% (23/38)	P < 0.001
40-49	4 (4-6)	Kruskal-Wallis test	45.1% (51/113)	χ2 test
50-59	4 (2-6)		34.7% (66/190)
60-69	4 (2-4)		18.3% (48/262)
≥ 70	2 (0-4)		9.9% (17/171)
Male sex	4 (2-4)	P < 0.001	23.5% (130/554)	P = 0.003
Female sex	4 (2-6)	Mann-Whitney U test	34.1% (75/220)	χ2 test
BMI
≥ 25	4 (2-6)	P = 0.796	27.2% (62/228)	P = 0.773
< 25	4 (2-6)	Mann-Whitney U test	26.2% (143/546)	χ2 test
Height
< 150 cm	4 (2-5)	P = 0.007	25.7% (9/35)	P = 0.219
150-160 cm	4 (2-6)	Kruskal-Wallis test	29.4% (53/180)	χ2 test
160-170 cm	4 (2-4)		22.7% (75/330)
≥ 170 cm	4 (2-6)		29.7% (68/229)
Non-smoker	4 (2-6)	P = 0.003	26.5% (104/393)	P = 0.033
Past smoker	4 (2-4)	Kruskal-Wallis test	22.4% (57/255)	χ2 test
Current smoker	4 (2-6)		34.9% (44/126)
Non-drinker	4 (2-6)	P = 0.098	29.4% (91/309)	P = 0.291
Normal drinker	4 (2-4)	Kruskal-Wallis test	24.9% (96/386)	χ2 test
Heavy drinker	4 (2-4)		22.8% (18/79)
History of endoscopy (+)	4 (2-4)	P < 0.001	24.8% (180/727)	P < 0.001
History of endoscopy (-)	6 (4-7)	Mann-Whitney U test	53.2% (25/47)	χ2 test
History of gastrectomy (+)	2 (2-4)	P = 0.202	16.7% (3/18)	P = 0.428
History of gastrectomy (-)	4 (2-6)	Mann-Whitney U test	26.7% (202/756)	Fisher's exact test
Butylscopolamine (+)	2 (2-4)	P = 0.115	20.6% (14/68)	P = 0.249
Butylscopolamine (-)	4 (2-6)	(Mann-Whitney U test	27.1% (191/706)	χ2 test
Biopsy performed (+)	4 (2-6)	P = 0.461	39.1% (9/23)	P = 0.163
Biopsy performed (-)	4 (2-6)	Mann-Whitney U test	26.1% (196/751)	χ2 test
Lugol’s solution (+)	4 (2-6)	P = 0.950	40.0% (2/5)	P = 0.612
Lugol’s solution (-)	4 (2-6)	(Mann-Whitney U test	26.4% (203/769)	Fisher's exact test
Endoscope
Normal diameter	4 (2-6)	P = 0.737	28.6% (6/21)	P = 0.826
Small diameter	4 (2-6)	Mann-Whitney U test	26.4% (199/753)	χ2 test
Hiatal hernia (+)	4 (2-6)	P = 0.257	27.6% (113/410)	P = 0.472
Hiatal hernia (-)	4 (2-6)	Mann-Whitney U test	25.3% (92/364)	χ2 test
Sedation agent
No use	4 (2-6)	-	26.5% (205/774)	-
Pethidine alone	-		-
Midazolam alone	-		-
Pethidine and Midazolam	-		-

Number of endoscopists: 27. Range of median score: 0 to 6. Proportion of high discomfort responses: 0 to 60% (details are omitted). Kruskal-Wallis test result for median score: P < 0.001. χ² test result for proportion of high discomfort: P = 0.011. BMI: Body mass index.

Table 3 Discomfort for each factor in the sedation group (n = 941) and univariate analysis results

Discomfort score value median (quartile ranges)			Proportion of high discomfort (score 6 or higher)
Age
≤ 39	4 (2.5-6)	P < 0.001	40.5% (17/42)	P < 0.001
40-49	2 (2-4)	Kruskal-Wallis test	17.9% (35/195)	χ2 test
50-59	2 (0-4)		10.8% (26/241)
60-69	2 (0-4)		6.0% (21/348)
≥ 70	2 (0-2)		3.5% (4/115)
Male sex	2 (0-4)	P < 0.001	10.9% (43/396)	P = 0.942
Female sex	2 (2-4)	Mann-Whitney U test	11.0% (60/545)	χ2 test
BMI
≥ 25	2 (0-4)	P = 0.155	11.3% (31/275)	P = 0.837
< 25	2 (0-4)	Mann-Whitney U test	10.8% (72/666)	χ2 test
Height
< 150 cm	2 (1-4)	P = 0.185	13.9% (11/79)	P = 0.109
150-160 cm	2 (0-4)	Kruskal-Wallis test	9.6% (35/366)	χ2 test
160-170 cm	2 (0-4)		9.2% (29/314)
≥ 170 cm	2 (0-4)		15.4% (28/182)
Non-smoker	2 (0-4)	P < 0.001	10.1% (60/595)	P = 0.055
Past smoker	2 (0-4)	Kruskal-Wallis test	9.9% (23/232)	χ2 test
Current smoker	2 (2-4)		17.5% (20/114)
Non-drinker	2 (0-4)	P = 0.055	9.5% (43/452)	P = 0.001
Normal drinker	2 (0-4)	Kruskal-Wallis test	10.3% (44/426)	χ2 test
Heavy drinker	2 (1-5)		25.4% (16/63)
History of endoscopy (+)	2 (0-4)	P = 0.004	10.3% (90/875)	P = 0.018
History of endoscopy (-)	2 (2-4)	Mann-Whitney U test	19.7% (13/66)	χ2 test
History of gastrectomy (+)	2 (0-2.5)	P = 0.477	16.7% (2/12)	P = 0.631
History of gastrectomy (-)	2 (0-4)	Mann-Whitney U test	10.9% (101/929)	Fisher's exact test
Butylscopolamine (+)	2 (0-4)	P = 0.187	10.6% (47/443)	P = 0.755
Butylscopolamine (-)	2 (0-4)	Mann-Whitney U test	11.2% (56/498)	χ2 test
Biopsy performed (+)	2 (0-3.5)	P = 0.287	11.5% (3/26)	P = 0.757
Biopsy performed (-)	2 (0-4)	Mann-Whitney U test	10.9% (100/915)	Fisher's exact test
Lugol’s solution (+)	1 (0.5-1.5)	P = 0.35	0.0% (0/2)	P = 1.00
Lugol’s solution (-)	2 (0-4)	Mann-Whitney U test	11.0% (103/939)	Fisher's exact test
Endoscope
Normal diameter	2 (2-4)	P = 0.197	10.8% (4/37)	P = 1.00
Small diameter	2 (0-4)	Mann-Whitney U test	11.0% (99/904)	Fisher's exact test
Hiatal hernia (+)	2 (0-4)	P = 0.891	12.3% (45/365)	P = 0.279
Hiatal hernia (-)	2 (0-4)	Mann-Whitney U test	10.1% (58/576)	χ2 test
Sedation agent
No use	-		-
Pethidine alone	2 (0-4)	P < 0.001	11.7% (93/797)	P = 0.186
Midazolam alone	2 (0-4)	Kruskal-Wallis test	10.5% (2/19)	Fisher's exact test
Pethidine and Midazolam	0 (0-2)		6.4% (8/125)

Number of endoscopists: 27. Range of median score: 0 to 4. Range of proportion of high discomfort responses: 0 to 27.8% (details are omitted). Kruskal-Wallis test result for median score: P = 0.027. χ² test result for proportion of high discomfort: P = 0.216. BMI: Body mass index.

Table 4 Multiple regression analysis and impact of each factor for discomfort

	Regression coefficient	Upper limit of 95%CI	Lower limit of 95%CI	P value
Age (+ 1)	-0.08	-0.09	-0.07	< 0.001
Sex (male)	-0.45	-0.79	-0.10	0.013
BMI (+ 1)	-0.002	-0.03	0.03	0.903
Height (+ 1)	-0.02	-0.04	-0.003	0.024
Smoking status
Past smoker	-0.06	-0.32	0.20	0.638
Current smoker	0.35	0.02	0.67	0.036
Alcohol consumption
Normal drinker	-0.05	-0.27	0.18	0.680
Heavy drinker	0.20	-0.21	0.61	0.337
Has no endoscopic experience	0.22	-0.20	0.65	0.300
History of gastrectomy	0.36	-0.41	1.14	0.362
Butylscopolamine use	-0.04	-0.35	0.27	0.802
Biopsy performed	0.11	-0.51	0.72	0.729
Lugol’s solution use	1.02	-0.61	2.64	0.221
Normal diameter endoscope	0.48	-0.09	1.05	0.101
Hiatal hernia	0.34	0.11	0.57	0.003
Sedation agent
Pethidine alone	-1.47	-1.71	-1.22	< 0.001
Midazolam alone	-1.63	-2.61	-0.66	0.001
Pethidine and midazolam	-2.92	-3.36	-2.49	< 0.001

Maximum difference in discomfort among endoscopists (regression coefficient): 2.78 (details of each endoscopist were omitted). BMI: Body mass index.