title: "First look" unsedated transnasal esogastroduodenoscopy in patients with upper gastrointestinal bleeding? A prospective evaluation.
abstract: OBJECTIVE
  With small diameter endoscopes, transnasal esophagogastroduodenoscopy (t-EGD) is routinely performed. The aim of this prospective observational study was to evaluate the role of t-EGD for upper gastrointestinal bleeding (UGIB).
  
  
  METHODS
  One hundred and forty-five consecutive patients (mean age, 66±18.4 years) with suspicion of UGIB were classified a priori into 3 groups according to initial clinical presentation: (1) intensive care unit with EGD under sedation, (2) endoscopy unit with EGD under transient sedation and (3) unsedated t-EGD as "first look". Demographic, clinical and biological parameters, Rockall and Blatchford scores, endoscopic diagnosis and treatment, and outcome were analysed.
  
  
  RESULTS
  Unsedated t-EGD was attempted in 89 patients, performed in 52 (5 failures, 28 contraindications) and the procedure was converted under sedation for 2 patients. Based on ASA classification, clinical (blood pressure, hemodynamical failure) and biological variables (hemoglobin, platelets, creatinine), these patients were less severe than in the other groups. Pre-endoscopic Rockall and Blatchford scores were significantly lower in this group. More patients in this group presented significant cardiovascular co-morbidity (47.2%), taking aspirin, clopidogrel and/or anticoagulant.
  
  
  CONCLUSIONS
  Our results strongly support that "first look" unsedated t-EGD can avoid unnecessary sedation in selected patients with UGIB, presenting a low probability for endoscopic haemostatic treatment and high sedation risks.
authors.affiliation: Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rivory
authors.affiliation: Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lépilliez
authors.affiliation: Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France.
authors.forename: Rodica
authors.initials: R
authors.lastname: Gincul
authors.affiliation: Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.affiliation: Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Vallin
authors.affiliation: Hospices civils de Lyon, hôpital Edouard-Herriot, département d'anesthésie-réanimation, Lyon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Bouffard
authors.affiliation: Hospices civils de Lyon, hôpital Edouard-Herriot, département d'anesthésie-réanimation, Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Sagnard
authors.affiliation: Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.affiliation: Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France. Electronic address: jerome.dumortier@chu-lyon.fr.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors