title: Analysis of cardiopulmonary stress during endoscopy: is unsedated transnasal esophagogastroduodenoscopy appropriate for elderly patients?
abstract: BACKGROUND
  Transnasal esophagogastroduodenoscopy (EGD) without sedation has been reported to be safe and tolerable. It has recently been used widely in Japan for the detection of upper gastrointestinal disease. Alternatively, transoral examination using a thin endoscope has also been reported to be highly tolerable.
  
  
  OBJECTIVE
  To examine the cardiocirculatory effects of transoral versus transnasal EGD in an attempt to determine the most suitable endoscopic methods for patients ≥75 years of age.
  
  
  METHODS
  Subjects who underwent monitoring of respiratory and circulatory dynamics without sedation during endoscopic screening examinations were enrolled at the New Ooe Hospital (Kyoto, Japan) between April 2008 and March 2009. A total of 165 patients (age ≥75 years) provided written informed consent and were investigated in the present study. Patients were randomly divided into three subgroups: UO group--thin endoscope; SO group--standard endoscope; and UT group--transnasal EGD. Percutaneous arterial blood oxygen saturation, heart rate and blood pressure were evaluated just before EGD and at five time points during EGD. After transnasal EGD, patients who had previously been examined using transoral EGD with a standard endoscope were asked about preferences for their next examination.
  
  
  RESULTS
  There were no statistical differences in the characteristics among the groups. Percutaneous oxygen saturation in the UT group showed a transient drop compared with the SO and UO groups at the beginning of the endoscopic procedure. Heart rate showed no significant differences among the SO, UO and UT groups; Systolic blood pressure in the UO group was lower immediately after insertion compared with the SO and UT groups. The rate pressure product in the UO group was comparable with that in the UT group during endoscopy, and the SO group showed a continuously higher level than the UO and UT groups. More than one-half (54.4%) of patients were 'willing to choose transnasal EGD for next examination'.
  
  
  CONCLUSIONS
  For elderly patients, unsedated transnasal EGD failed to show an advantage over unsedated standard endoscopy. Transoral thin EGD was estimated to be safe and tolerable.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Sakamoto
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kajikawa
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Takagi
authors.forename: Osamu
authors.initials: O
authors.lastname: Handa
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Tatsumi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Yagi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Naito
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Itoh
authors.forename: Shuhei
authors.initials: S
authors.lastname: Takemura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001785:Blood Gas Monitoring, Transcutaneous / Q000379:methods; D001794:Blood Pressure; D016145:Endoscopy, Digestive System / Q000379:methods*; D004867:Equipment Design; D005260:Female; D016330:Frail Elderly; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006339:Heart Rate; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D008297:Male; D009055:Mouth; D009666:Nose; D010101:Oxygen Consumption; D010147:Pain Measurement; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055986:Vital Signs