title: Modified Mallampati classification as a clinical predictor of peroral esophagogastroduodenoscopy tolerance.
abstract: BACKGROUND
  Unsedated esophagogastroduodenoscopy (EGD) is simpler and safer than sedated EGD; however, approximately 40% of patients cannot tolerate it. Early identification of patients likely to poorly tolerate unsedated EGD is valuable for improving compliance. The modified Mallampati classification (MMC) has been used to evaluate difficult tracheal intubation and laryngoscope insertion. We tried to assess the efficacy of MMC to predict the tolerance of EGD in unsedated patients.
  
  
  METHODS
  Two hundred patients who underwent an unsedated diagnostic EGD were recruited. They were stratified according to the view of the oropharynx as either MMC class I + II (good view) or class III + IV (poor view). EGD tolerance was assessed in three ways: gag reflex by endoscopist assessment, patient satisfaction by interview, and the degree of change in vital signs.
  
  
  RESULTS
  MMC was significantly correlated to gag reflex (P < 0.001), patient satisfaction (P = 0.028), and a change of vital signs (P = 0.024). Patients in the poor view group had a 3.87-fold increased risk of gag reflex (P < 0.001), a 1.78-fold increased risk of unsatisfaction (P = 0.067), and a 1.96-fold increased risk of a change in vital signs (P = 0.025) compared to those in the good view group.
  
  
  CONCLUSIONS
  MMC appears to be a clinically useful predictor of EGD tolerance. Patients with poor view of oropharynx by MMC criteria may be candidates for sedated or transnasal EGD.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan.
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Huang
authors.forename: Meei-Shyuan
authors.initials: MS
authors.lastname: Lee
authors.forename: Yu-Lueng
authors.initials: YL
authors.lastname: Shih
authors.forename: Heng-Cheng
authors.initials: HC
authors.lastname: Chu
authors.forename: Tien-Yu
authors.initials: TY
authors.lastname: Huang
authors.forename: Tsai-Yuan
authors.initials: TY
authors.lastname: Hsieh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005260:Female; D005683:Gagging; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D005931:Glottis / Q000033:anatomy & histology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010160:Palate, Soft / Q000033:anatomy & histology*; D017060:Patient Satisfaction; D010437:Peptic Ulcer / Q000175:diagnosis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014609:Uvula / Q000033:anatomy & histology*; D055815:Young Adult