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 18 February 2018

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Predicting which patients can undergo upper endoscopy comfortably without conscious sedation

Increasing age and decreased pharyngeal sensitivity are the only independent predictors of a satisfactory upper endoscopy, finds a Canadian study investigating factors useful in predicting the success of unsedated diagnostic upper endoscopies.

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Elimination of the necessity for conscious sedation in diagnostic endoscopy procedures has advantages both in terms of patient safety and also in reducing costs.

A study in the August issue of the journal Gastrointestinal Endoscopy has therefore examined whether independent predictors of a comfortable, technically adequate, unsedated diagnostic upper endoscopy can be identified and validated.

The study, carried out on patients in Canada, involved an initial 268 subjects enrolled in a prospective manner.

Data such as demographics, use of sedatives or analgesics, upper endoscopy experience, technical adequacy and pharyngeal sensitivity were collected from each subject.

In addition, each patient completed a validated anxiety questionnaire and carried out an assessment of comfort after the procedure.

The main outcome measure of the survey was "satisfactory upper endoscopy", a composite of optimal scores for patient comfort and technical adequacy.

Univariate and multivariate analyses were performed to identify the optimal predictive model of a satisfactory unsedated diagnostic upper endoscopy.

Once identified, a further 68 patients were enrolled to the study in a similar fashion from an independent prospective sample, for purposes of outcome validation.

Multivariate analysis was then repeated with the total cohort (n = 336) and these results were compared for concordance with those obtained from the initial cohort.

Among the initial 268 patients (54.3% women, mean age 51 ± 17 years), a total of 49% were found to be anxious, while 15% regularly used sedatives and analgesics, 28% experienced pharyngeal sensitivity and 41% had previously undergone upper endoscopy.

Endoscopy was completed in slightly fewer than 95% of patients without sedation, and was technically adequate in 97%.

Unsedated upper endoscopy:
Only modest numbers of patients suitable
Gastrointestinal Endoscopy

80% of patients said they would be willing to repeat the procedure under similar conditions.

However, satisfactory upper endoscopy was achieved in only 59% of the initial cohort.

The only independent and significant predictors of a satisfactory upper endoscopy were advancing age and decreased pharyngeal sensitivity.

A satisfactory endoscopy was achieved in only 59.5% of the total cohort (n = 336), while only 61% reported a comfortable procedural experience.

Commenting on the findings, Dr Neena Abraham, one of the report authors', said, "The proportion of patients who can undergo technically adequate unsedated upper endoscopy is modest."

"Unsedated upper endoscopy is most likely to be successful under these procedural conditions in patients of advancing age with decreased pharyngeal sensitivity."

Although cautioning as to the generalizability of these current findings to an American population, Dr Abraham said that further study may assist in identifying a subgroup of patients in whom it is cost-effective to perform upper endoscopy comfortably without sedation.

Gastrointest Endosc 2002; 56(2): 180-189
06 August 2002

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