Unsedated upper endoscopy in children.
BACKGROUND
EGD is essential to the investigation and treatment of GI disorders in children. Although safe, EGD has the potential for complications, in particular cardiopulmonary abnormalities associated with intravenous sedation. EGD is often performed in adults without sedation. Unsedated EGD is occasionally performed in children but has not been subjected to study. This study assessed the safety, efficacy, and feasibility of unsedated EGD in children.


METHODS
Selected, highly motivated children requiring EGD were offered the choice of sedation or no sedation for the procedure. Children recorded scores for pain (face scale) and anxiety (vertical visual analogue scale) before and after EGD. In addition, the times required to prepare the patient, perform the EGD, and recover the patient were recorded.


RESULTS
There was no difference in age, gender, or pre-EGD pain scores between children selecting sedation or no sedation. However, children selecting sedation had significantly higher pre-EGD anxiety scores than those who chose no sedation. Successful completion of EGD was similar for sedated (96.3%) and unsedated (95.2%) children. Post-EGD scores for anxiety were significantly decreased in those receiving sedation and unchanged in children who received no sedation. There was no significant change in post-EGD pain score in either group. Nearly 80% of children undergoing unsedated EGD would elect to forego sedation if EGD was needed again. Total procedure time was significantly longer in sedated versus unsedated children, reflecting longer preparation and recovery.


CONCLUSIONS
Unsedated EGD can be performed safely and successfully in children with good patient tolerance. There was a significant decrease in total procedure time for children who have unsedated EGD. Unsedated EGD should be considered a viable option for motivated children.
Bishop
Phyllis R
PR
Division of Pediatric Gastroenterology and Nutrition, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
Nowicki
Michael J
MJ
May
Warren L
WL
Elkin
David
D
Parker
Paul H
PH
D000293:Adolescent; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D016292:Procedural Sedation; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000473:pathology*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D013997:Time Factors