title: Comparison of thin versus standard esophagogastroduodenoscopy.
abstract: 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.
authors.affiliation: Department of Family Practice, Malcolm Grow Medical Center, Andrews Air Force Basse, Marylannd, USA. twilkins@mail.mcg.edu
authors.forename: Thad
authors.initials: T
authors.lastname: Wilkins
authors.forename: Albert
authors.initials: A
authors.lastname: Brewster
authors.forename: Jonathon
authors.initials: J
authors.lastname: Lammers
mesh_terms: 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