Gastrointestinal Endoscopy
Volume 56, Issue 2 , Pages 180-189 , August 2002

Predicting which patients can undergo upper endoscopy comfortably without conscious sedation

Received 10 July 2001 ,Revised 12 October 2001 ,Accepted 20 February 2002.

References 

  1. Health and public policy committee, American College of Physicians . Clinical competence in diagnostic esophagogastroduodenoscopy. Ann Int Med. 1987;107:937–939
  2. Scott BB. Gastroenterology in the Trent region in 1992 and a review of changes since 1975. Gut. 1995;36:468–472
  3. Lalor E, Thomson AB. Comparison of the utilization of endoscopy units in selected teaching hospitals across Canada. Can J Gastroenterol. 1996;10:381–384
  4. Froehlich F, Gonvers JJ, Fried M. Conscious sedation, clinically relevant complications, and monitoring of endoscopy: results of a nationwide survey in Switzerland. Endoscopy. 1994;26:231–234
  5. Lieberman DA, Wuerker CK, Katon RM. Cardiopulmonary risk of esophagogastroduodenoscopy. Role of endoscopic diameter and systemic sedation. Gastroenterology. 1985;88:468–472
  6. Keefe EB, Schrock TR. Complications of gastrointestinal endoscopy. In:  Sleisenger MH editors. 5th ed. Philadelphia: Saunders; 1993;p. 301–308
  7. Fleischer D. Monitoring for sedation: perspective of the gastrointestinal endoscopist. Gastrointest Endosc. 1990;36:S19–S22
  8. Keefe B, O'Connor K. 1989 ASGE survey of endoscopic sedation and monitoring practices. Gastrointest Endosc. 1990;36:S13–S18
  9. Bailey RJ, Barkun A, Brow J, Champion M, Deneault J, Fedorak R, et al.  Consensus in endoscopy. Can J Gastroenterol. 1996;10:237–242
  10. Hoare AM, Hawkins CF. Upper gastrointestinal endoscopy with and without sedation: patients' opinions [abstract]. Brit Med J. 1976;2:20
  11. Al-Altrakchi HA. Upper gastrointestinal endoscopy without sedation: a prospective study of 2000 examinations. Gastrointest Endosc. 1989;35:79–81
  12. Hedenbro JL, Lindbolm A. Patient attitudes to sedation for diagnostic upper endoscopy. Scand J Gastroenterol. 1991;26:1115–1120
  13. Pereira SP, Hussaini SH, Hanson PJV, Wilkinson ML, Sladen GE. Endoscopy: throat spray or sedation?. J Royal Coll Physicians London. 1994;28:411–414
  14. Campo R, Brullet E, Montserrat A, Calvet X, Moix J, Rue M, et al.  Identification of factors that influence tolerance of upper gastrointestinal endoscopy. Eur J Gastro and Hep. 1999;111:201–204
  15. Froehlich F, Schwizer W, Thorens J, Kohier M, Gonvers JJ, Fried M. Conscious sedation for gastroscopy: patient tolerance and cardiorespiratory parameters. Gastroenterology. 1995;108:697–704
  16. Zigmond A, Snaith R. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370
  17. Schutz SM, Lee JG, Schmitt CM, Almon M, Baillie J. Clues to patient dissatisfaction with sedation for colonoscopy. Am J Gastroenterol. 1994;89:1476–1479
  18. Walmsley RS, Montgomery SM. Factors affecting patient tolerance of upper gastrointestinal endoscopy. J Clin Gastroenterol. 1998;26:253–255
  19. Streiner DL, Norman GR. Health measurement scales. In: 2nd ed. Scaling responses. New York: Oxford University Press; 1995;p. 28–53
  20. Kass R, Raftery A. Bayes Factors. JASA. 1995;90:773–795
  21. Hosmer DW, Lemeshow S. Assessing the fit of the model. In:  Hosmer DW,  Lemeshow S editor. Applied logistic regression. New York: Wiley Interscience; 1989;p. 137
  22. Barkun AN, Barkun JS, Fried GM, Ghitulescu G, Steinmetz O, Pham C, et al.  Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. Ann Surg. 1994;220:32–39
  23. Fisher NC, Bailey S, Gibson JA. A prospective randomized controlled trial of sedation vs. no sedation in outpatient diagnostic upper gastrointestinal endoscopy. Endoscopy. 1998;30:21–24
  24. Waye J. Worldwide use of sedation and analgesia for upper intestinal endoscopy [editorial]. Gastrointest Endosc. 1999;50:888–891
  25. Barkun AN, Parent J. Gastrointestinal endoscopy—a Canadian perspective. Gastrointest Endosc. 1998;47:557–559
  26. Ross WA. Premedication for upper gastrointestinal endoscopy. Gastrointest Endosc. 1989;35:120–125
  27. Sorbi D, Gostout CJ, Henry J, Lindork D. Unsedated small-caliber esophagogastroduodenoscopy (EGD) versus conventional EGD: a comparative study. Gastroenterology. 1999;117:1301–1307
  28. Rey JF. Sedation for upper gastrointestinal endoscopy: as much as possible, or without [letter]?. Endoscopy. 1996;28:308–309
  29. Mulcahy HE, Hennessy E, Connor P, Rhodes B, Patchett SE, Farthing MJG, et al.  Changing patterns of sedation use for routine out-patient diagnostic gastroscopy between 1989 and 1998. Aliment Pharmacol Ther. 2001;15:217–220
  30. Pound DC, O'Connor KW, Brown ED, Weddle R, McHenry R, Crabb D, et al.  Oral medications for upper gastrointestinal endoscopy using a small diameter endoscope. Gastrointest Endosc. 1988;34:327–331
  31. Campo R, Brullet E, Montserrat A, Calvet X, Rivero E, Brotons C. Topical pharyngeal anesthesia improves tolerance of upper gastrointestinal endoscopy: a randomized double-blind study. Endoscopy. 1995;27:659–664
  32. Hedenbro JL, Ekelund M, Jansson O, Lindblom A. A randomized, double-blind, placebo-controlled study to evaluate topical anaesthesia of the pharynx in upper gastrointestinal endoscopy. Endoscopy. 1992;24:585–587
  33. Jameson JS, Kapadia SA, Polson RJ, McCarthy PT, Misiewicz JJ. Is oropharyngeal anaesthesia with topical lignocaine useful in upper gastrointestinal endoscopy?. Aliment Pharmacol Ther. 1992;6:739–744
  34. Hedenbro JL, Ekelund M, Jansson O, Lindblom A. A randomized, double-blind, placebo-controlled study to evaluate topical anaesthesia of the pharynx in upper gastrointestinal endoscopy. Endoscopy. 1992;24:585–587
  35. Lachter J, Jacobs R, Lavy A, Weisler A, Suissa A, Enat R, et al.  Topical pharyngeal anesthesia for easing endoscopy: a double-blind, randomized, placebo-controlled study. Gastrointest Endosc. 1990;36:19–21
  36. Davis DE, Jones MP, Kubik CM. Topical pharyngeal anesthesia does not improve upper gastrointestinal endoscopy in conscious sedated patients. Am J Gastro. 1999;94:1853–1856
  37. Zimmerman J, Rachmilewitz D. Systemic anaphylactic reaction following lidocaine administration. Gastrointest Endosc. 1985;31:404–405
  38. Patel D, Chopra S, Berman MD. Serious systemic toxicity resulting from use of tetracaine for pharyngeal anesthesia in upper endoscopic procedures. Dig Dis Sci. 1989;34:882–884
  39. Shua-Haim JR, Gross JS. Methemoglobinemia toxicity from topical benzocaine spray [letter]. J Am Geriatr Soc. 1995;43:590
  40. Gunaratnam NT, Vazquez-Sequeiros E, Gostout CJ, Alexander GL. Methemoglobinemia is related to topical benzocaine use: is it time to reconsider the empiric use of topical anesthesia before sedated EGD?. Gastrointest Endosc. 2000;52:692–693
  41. Zuberi BF, Shaikh MR, Jatoi NU, Shaikh WM. Lidocaine toxicity in a student undergoing upper gastrointestinal endoscopy [letter]. Gut. 2000;46:435
  42. Mulcahy HE, Greaves RR, Ballinger A, Patchett SE, Riches A, Fairclough PD. A double-blind randomized trial of low-dose versus high-dose topical anaesthesia in unsedated upper gastrointestinal endoscopy. Aliment Pharmacol Ther. 1996;10:975–979
  43. Tan CC, Freeman JG. Throat spray for upper gastrointestinal endoscopy is quite acceptable to patients. Endoscopy. 1996;28:277–282
  44. Bell GD. Review article: premedication and intravenous sedation for upper gastrointestinal endoscopy. Aliment Pharmacol Ther. 1990;4:103–122
  45. Zaman A, Hapke R, Sahagun G, Katon R. Unsedated peroral endoscopy with a video ultrathin endoscope: patient acceptance, tolerance, and diagnostic accuracy. Am J Gastroenterol. 1998;93:1260–1263
  46. McAlpine JK, Martin BJ, Devine BL. Cardiac arrhythmias associated with upper gastrointestinal endoscopy in elderly subjects. Scott Med J. 1990;35:102–104
  47. Scott-Coombes DM, Thompson JN. Hypoxia during upper gastrointestinal endoscopy is caused by sedation. Endoscopy. 1993;25:308–309
  48. Lieberman DA, Wuerker CK, Katon RM. Cardiopulmonary risk of esophagogastroduodenoscopy: role of endoscopic diameter and systemic sedation. Gastroenterology. 1985;88:468–472
  49. Lazzaroni M, Bianchi Porro G. Preparation, premedication and surveillance. Endoscopy. 1998;30:53–60
  50. Yacavone R, Locke G, Gostout C, Rockwood T, Thieling S, Zinsmeister AR. Factors influencing patient satisfaction with GI endoscopy. Gastrointest Endosc. 2001;53:703–710
  51. Abraham NS, Huang J, Wieczorek P, Mayrand S, Barkun AN. The impact of sedation versus no sedation in the performance of upper gastrointestinal endoscopy [abstract]. Gastrointest Endosc. 2000;51:AB59
  52. Abraham NS, Wieczorek P, Huang I, Mayrand S, Barkun AN. Assessing bias in sedation studies [abstract]. Gastrointest Endosc. 2000;51:AB75
  53. Campo R, Montserrat A, Brullet F. Transnasal gastroscopy compared to conventional gastroscopy: a randomized study of feasibility, safety, and tolerance. Endoscopy. 1998;30:448–452
  54. Craig A, Hanlon J, Dent J, Schoeman M. A comparison of transnasal and transoral endoscopy with small-diameter endoscopes in unsedated patients. Gastrointest Endosc. 1999;49:292–296
  55. Dumortier I, Ponchon T, Scoazec JY, Moulinier B, Zarka F, Paliard P, et al.  Prospective evaluation of transnasal esophagogastroduodenoscopy: feasibility and study on performance and tolerance. Gastrointest Endosc. 1999;49:285–291
  56. ASGE . Ultrathin endoscopes esophagogastroduodenoscopy. Technology status evaluation report. Gastrointest Endosc. 2000;51:786–789
  57. Saeian K, Townsend WR, Rochling FA, Bardan E, Dua K, Phadnis S, et al.  Unsedated transnasal EGD: an alternative approach to conventional esophagogastroduodenoscopy for documenting Helicobacter pylori eradication. Gastrointest Endosc. 1999;49:297–301

 Dr. N.S. Abraham is the recipient of a Canadian Association of Gastroenterology-Carsen Group-Medical Research Council of Canada Fellowship in GI Endoscopic Research. Dr. AN Barkun, Dr. CA Fallone, and Dr. L Joseph are Research Scholars funded by the Fonds de la Recherche en Santé du Québec.

☆☆ The pilot study was funded in part by the American College of Gastroenterology and the Helen McCall Hutchison Foundation Fellowship.

 Reprint requests: Alan N. Barkun, MD, Room D7.148, 1650 Cedar Ave., Montréal, Québec, Canada, H3G 1A4.

PII: S0016-5107(02)70175-2

Gastrointestinal Endoscopy
Volume 56, Issue 2 , Pages 180-189 , August 2002