Comparison of thin versus standard esophagogastroduodenoscopy.
OBJECTIVE
To compare the tolerance, feasibility, and safety of ultrathin esophagogastroduodenoscopy (EGD) in unsedated patients with conventional EGD in sedated patients.


METHODS
This was an unblinded, randomized controlled trial.


METHODS
Diagnostic EGD was performed on 72 adult outpatients at a US Air Force community hospital residency. Patients were randomized to either ultrathin or conventional EGD (n = 33 and 39, respectively).


METHODS
Patients reported their tolerance of the procedure (pain, choking, gagging, and anxiety; scale 0-10), and the endoscopist reported the effectiveness of the procedure (successful intubation, reaching duodenum, retroflexion, and duration of examination and recovery) and safety (complications).


RESULTS
No statistically significant difference was noted between the 2 groups in mean procedure time or pain during the procedure. Mean ( standard error) recovery time was approximately halved in the ultrathin group vs the conventional group (21.5 +/- 2.3 min vs 55.4 +/- 2.3 min, P < 0001). Although patients undergoing ultrathin EGD had higher mean gagging and choking scores, they had lower mean anxiety scores. Of 33 patients randomized to the unsedated ultrathin EGD procedure, 29 completed the protocol. The retroflexion maneuver was completed in 85% of patients in the ultrathin EGD group and 100% of patients in the conventional EGD group (P =.017). No statistically significant difference was noted between groups as to the likelihood of reaching the second portion of the duodenum (97% vs 100%).


CONCLUSIONS
Most patients tolerate ultrathin EGD with significantly shorter recovery time and less overall anxiety than with the conventional procedure. Techniques to reduce gagging and choking associated with ultrathin EGD may improve patient acceptance and tolerability. Adoption of ultrathin EGD by primary care physicians may decrease cost, time, and inconvenience while increasing access to EGD for many patients.
Wilkins
Thad
T
Department of Family Practice, Malcolm Grow Medical Center, Andrews Air Force Basse, Marylannd, USA. twilkins@mail.mcg.edu
Brewster
Albert
A
Lammers
Jonathon
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D016292:Procedural Sedation; D016145:Endoscopy, Digestive System / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005683:Gagging / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010342:Patient Acceptance of Health Care; D012044:Regression Analysis; D012449:Safety; D018709:Statistics, Nonparametric