Unsedated upper endoscopy is an attractive alternative to conventional sedated endoscopy because it can reduce the cost, complications, and recovery time of the procedure.
| The transnasal route was better tolerated than the transoral route, except with respect to pain|
However, it has not gained widespread acceptance in the United States.
A prototype 4-mm-diameter video esophagoscope is available.
Dr Thota and colleagues from Ohio compared unsedated esophagoscopy using this 4-mm esophagoscope with conventional sedated endoscopy.
The research team analyzed diagnostic accuracy and patient tolerance, to determine the optimal intubation route of transnasal versus transoral.
The team also identified the predictors of tolerance of unsedated endoscopy.
The researchers randomized outpatients presenting for conventional endoscopy to undergo unsedated esophagoscopy by either the transnasal or the transoral route, followed by conventional endoscopy.
The diagnostic findings, optical quality, and patient tolerance scores were assessed by the team.
Of the 137 patients approached, 90 patients were included.
The team reported that 44 patients were randomized to undergo esophagoscopy by the transnasal route and 46 by the transoral route before undergoing conventional esophagoscopy.
The team found that patient tolerance of unsedated esophagoscopy was comparable to that of conventional endoscopy.
The researchers observed that the transnasal route was better tolerated than the transoral route, except with respect to pain.
The team noted that 93 % in transnasal group and 91 % in transoral group were willing to have the procedure again.
The diagnostic accuracy of endoscopy using the 4-mm video endoscope was similar to that of standard endoscopy.
The team found that patients who tolerated the procedure well had lower preprocedure anxiety scores and a higher body mass index than the other patients.
Dr Thota's team concludes, “Unsedated esophagoscopy with a 4-mm esophagoscope was well tolerated and has a level of diagnostic accuracy comparable to that of conventional endoscopy.”
“Factors associated with good tolerance of unsedated esophagoscopy were low anxiety levels, high body mass index, and use of the transnasal route.”
“Unsedated endoscopy may be offered to a selected group of patients based on these criteria.”