title: Factors associated with tolerance to, and discomfort with, unsedated diagnostic gastroscopy.
abstract: BACKGROUND
  Identification of patients likely to experience high levels of discomfort during unsedated gastroscopy would be useful as these patients could be prospectively targeted for sedation. We prospectively assessed patient and endoscopic variables in subjects attending for endoscopy in order to identify factors associated with patients' experience of the unsedated examination.
  
  
  METHODS
  We studied 508 patients attending for routine diagnostic gastroscopy. Clinical and endoscopic data were collected and patients completed a two-part questionnaire assessing their anxiety with, and experience of, the procedure.
  
  
  RESULTS
  Thirty-nine subjects failed to complete the initial unsedated endoscopy. Failure to tolerate endoscopy was associated with younger age (P = 0.002) and examination with a standard-bore (> or = 9.0 mm) endoscope (P = 0.004). High levels of patient discomfort during the procedure were associated with younger age (P < 0.001), high levels of pre-endoscopic anxiety (P < 0.001), high levels of pre-endoscopic discomfort due to throat spray (P = 0.02) and examination with a standard-bore endoscope (P < 0.001). Preference for sedation during future examinations was related to female gender (P = 0.02), young age (P = 0.02), high levels of apprehension (P < 0.001), the examining doctor (P = 0.002) and use of a standard-bore endoscope (P < 0.001).
  
  
  CONCLUSIONS
  Discrete clinical characteristics and endoscopic variables are associated with patients' experience of unsedated endoscopy. Further work might result in an algorithm for identifying patients who would benefit from sedation prior to gastroscopy.
authors.affiliation: Dept. of Gastroenterology, Homerton Hospital, London, UK. hemulc@hotmail.com
authors.forename: H E
authors.initials: HE
authors.lastname: Mulcahy
authors.forename: P
authors.initials: P
authors.lastname: Kelly
authors.forename: M R
authors.initials: MR
authors.lastname: Banks
authors.forename: P
authors.initials: P
authors.lastname: Connor
authors.forename: S E
authors.initials: SE
authors.lastname: Patchet
authors.forename: M J
authors.initials: MJ
authors.lastname: Farthing
authors.forename: P D
authors.initials: PD
authors.lastname: Fairclough
authors.forename: P J
authors.initials: PJ
authors.lastname: Kumar
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D005773:Gastroscopy; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D018579:Patient Selection; D011446:Prospective Studies; D012044:Regression Analysis; D012737:Sex Factors
chemical_list: D006993:Hypnotics and Sedatives