title: Unsedated small-caliber esophagogastroduodenoscopy (EGD) versus conventional EGD: a comparative study.
abstract: OBJECTIVE
  Significant portions of the cost and complications of esophagogastroduodenoscopy (EGD) are related to sedation. This study aimed to assess the feasibility, acceptability, and accuracy of unsedated small-caliber transoral EGD (sc-EGD).
  
  
  METHODS
  A 4-phase study was performed in healthy volunteers and patients. Phases 1 and 2 involved assessment of the technical feasibility of sedated sc-EGD and the tolerability of unsedated sc-EGD, respectively, in volunteers. Subsequently, the technical feasibility, tolerability, and diagnostic accuracy of sedated and unsedated sc-EGD were determined by having each patient undergo sc-EGD (Pentax EG-1840) with (phase 3) and without (phase 4) sedation, followed by sedated conventional EGD (c-EGD) (Olympus GIF-100 or GIF-Q140) by a staff endoscopist blinded to the findings of the sc-EGD. The t test for paired samples was used for statistical analysis. A P value of <0.05 was considered significant.
  
  
  RESULTS
  Sedated and unsedated sc-EGD were technically feasible and tolerable in all volunteers. In patients, compared with sedated c-EGD, sedated and unsedated sc-EGD were 96% and 97% accurate, respectively. The overall acceptability of unsedated sc-EGD was only slightly worse than that of sedated c-EGD (median, 2 vs. 1 on a scale of 1-10). After unsedated sc-EGD, 98% of patients expressed willingness to undergo the procedure again. No complications were observed during any phase of the study.
  
  
  CONCLUSIONS
  Unsedated sc-EGD is technically feasible, tolerable, and accurate. It can potentially decrease the costs and complications of sedated conventional EGD.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
authors.forename: D
authors.initials: D
authors.lastname: Sorbi
authors.forename: C J
authors.initials: CJ
authors.lastname: Gostout
authors.forename: J
authors.initials: J
authors.lastname: Henry
authors.forename: K D
authors.initials: KD
authors.lastname: Lindor
mesh_terms: D000328:Adult; D000368:Aged; D004415:Dyspepsia / Q000175:diagnosis; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011786:Quality Control
chemical_list: D006993:Hypnotics and Sedatives