title: Utility of unsedated transnasal endoscopy for pharyngeal observation during esophagogastroduodenoscopy. A prospective study to assess cardiopulmonary function.
abstract: OBJECTIVE
  Emergence of image-enhanced endoscopy has enabled an early detection of pharyngeal carcinoma. Pharyngeal observation during esophagogastroduodenoscopy (EGD) is sometimes difficult because of excessive reflexes and is a great burden to the patients and impacts on their cardiopulmonary function. In this study, the authors aimed to evaluate the utility of transnasal EGD (TN-EGD) in comparison with sedated and unsedated transoral EGD (TO-EGD) in pharyngeal observation using a continuous monitoring device.
  
  
  METHODS
  A total of 70 patients receiving diagnostic EGD (unsedated TN-EGD, sedated TO-EGD, and unsedated TO-EGD) were enrolled in this study and were evaluated by the following three criteria: (1) numbers of patients with excessive gag and/or cough reflex, (2) vital signs before and during the pharyngeal observation, and (3) response to the request for vocalization or breath-holding.
  
  
  RESULTS
  Unsedated TN-EGD, sedated TO-EGD, and unsedated TO-EGD were performed in 30, 20, and 20 patients, respectively. The rate of gag reflex was significantly lower in TN-EGD than in both types of TO-EGD (0% vs. 30%, chi-square test, p < 0.005). The changes in average values of both arterial oxygen saturation (SpO2) and pulse rate (PR) in TN-EGD were smaller than those in sedated TO-EGD (-0.23% vs. -1.23% in SpO2 and 1.57 vs. 8.11 bpm in PR, p < 0.01, respectively). Unsedated TN-EGD patients could respond to the instructions of utterance and breath-holding during the observation (p < 0.05, p < 0.001, respectively).
  
  
  CONCLUSIONS
  Unsedated TN-EGD is safe and feasible for pharyngeal observation during normal EGD examination.
authors.affiliation: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Tsuboi
authors.forename: Makoto
authors.initials: M
authors.lastname: Arai
authors.forename: Daisuke
authors.initials: D
authors.lastname: Maruoka
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Matsumura
authors.forename: Tomoo
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Katsuno
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062485:Breath Holding; D016292:Procedural Sedation; D004724:Endoscopy / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005683:Gagging; D006801:Humans; D006993:Hypnotics and Sedatives; D016015:Logistic Models; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010610:Pharyngeal Neoplasms / Q000175:diagnosis; D010614:Pharynx / Q000473:pathology / Q000502:physiology; D011446:Prospective Studies; D014705:Verbal Behavior; D055986:Vital Signs
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam