title: Patient tolerance and acceptance of unsedated ultrathin esophagoscopy.
abstract: BACKGROUND
  Unsedated endoscopy has not gained wide acceptance in the United States. Factors that may predict tolerance and acceptance of unsedated endoscopy are ill defined.
  
  
  METHODS
  Outpatients referred for standard EGD were recruited to undergo unsedated ultrathin esophagoscopy (UUE) with a new 3.1-mm battery-powered esophagoscope before sedated EGD. They rated preprocedure and postprocedure anxiety levels with the Profile of Mood States Tension/Anxiety subscale (POMS-SF T/A). They also rated symptoms and overall acceptability and listed procedural preference between EGD and UUE. Patients who refused UUE noted a reason for refusal and also completed the anxiety questionnaire.
  
  
  RESULTS
  Fifty-two of 98 patients recruited agreed to participate, and underwent both UUE and EGD. Patients who refused UUE were significantly more anxious (mean anxiety score, 8.2 vs. 4.5, p < 0.005). Participants reported no significant difference between preprocedural (4.6 vs. 5.3) or postprocedural (3.5 vs. 2.6) anxiety for UUE versus standard EGD. After undergoing both procedures, only 46% stated they would prefer UUE to EGD in the future. Patients who chose the peroral approach were more likely to prefer UUE than those who chose the transnasal approach (58% vs. 23%, p = 0.02).
  
  
  CONCLUSIONS
  Patient acceptance of unsedated endoscopy even with an ultrathin instrument is limited. Anxiety assessment by the POMS-SF T/A can identify patients willing to undergo UUE. Patients who choose transoral UUE may be more willing to repeat the procedure.
authors.affiliation: Division of Gastroenterology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106, USA.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Faulx
authors.forename: Andrew
authors.initials: A
authors.lastname: Catanzaro
authors.forename: Stephen
authors.initials: S
authors.lastname: Zyzanski
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Pfau
authors.forename: Gerard
authors.initials: G
authors.lastname: Isenberg
authors.forename: Richard C K
authors.initials: RC
authors.lastname: Wong
authors.forename: Michael V
authors.initials: MV
authors.lastname: Sivak
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology; D016292:Procedural Sedation; D004935:Esophageal Diseases / Q000473:pathology* / Q000601:surgery*; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011581:Psychological Tests