title: Cardiovascular tolerance and autonomic nervous responses in unsedated upper gastrointestinal small-caliber endoscopy: a comparison between transnasal and peroral procedures with newly developed mouthpiece.
abstract: BACKGROUND
  Transnasal esophagogastroduodenoscopy (EGD) with small-caliber endoscopy appears to be less stressful to the cardiovascular system and has good patient tolerance. ENDO LEADER, a newly developed mouthpiece for peroral EGD with small-caliber endoscopy, is expected to reduce patient stress. We compared the patient acceptance, cardiovascular tolerance and autonomic nervous responses between transnasal EGD and peroral EGD with ENDO LEADER.
  
  
  METHODS
  A total of 130 patients (transnasal group, 77; peroral group, 53) were enrolled. Pulse rate (P), blood pressure (BP), and peripheral blood oxygen saturation (SpO(2) ) were monitored. Acceptance of EGD was also assessed. Autonomic nervous responses were evaluated through analysis of heart rate variability using amplitude of the high-frequency component (HF) and low-frequency-to-high-frequency power ratio (LF/HF) as indices of cardiac vagal activity and sympathetic activity, respectively.
  
  
  RESULTS
  Analysis of patient acceptance showed no differences between the two groups, except with regard to nasal pain. Increases in BP and P between before and during EGD examination were significantly higher in the peroral group. Although throat pain and overall tolerance scores were significantly correlated with ΔBP and ΔP, no correlations with nasal pain score were noted. Heart rate variability analysis revealed that heart rate increased significantly in the peroral group, but there were no differences in ΔHF or ΔLF/HF between the two groups.
  
  
  CONCLUSIONS
  Patient acceptance was not significantly different between the transnasal and peroral with ENDO LEADER groups; however, transnasal EGD appears to be less stressful to the sympathetic nervous system, leading to smaller elevations in BP, P and heart rate.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences Toei Clinic, Nagoya, Japan. hkataoka@med.nagoyacu.ac.jp
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kataoka
authors.forename: Junichiro
authors.initials: J
authors.lastname: Hayano
authors.forename: Takashi
authors.initials: T
authors.lastname: Mizushima
authors.forename: Mamoru
authors.initials: M
authors.lastname: Tanaka
authors.forename: Eiji
authors.initials: E
authors.lastname: Kubota
authors.forename: Takaya
authors.initials: T
authors.lastname: Shimura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Mizoshita
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kamiya
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nojiri
authors.forename: Seiji
authors.initials: S
authors.lastname: Mukai
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Mizuno
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System; D002319:Cardiovascular System; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D009666:Nose; D010342:Patient Acceptance of Health Care