title: Evaluation of preferable insertion routes for esophagogastroduodenoscopy using ultrathin endoscopes.
abstract: OBJECTIVE
  To evaluate the discomfort associated with esophagogastroduodenoscopy (EGD) using an ultrathin endoscope through different insertion routes.
  
  
  METHODS
  This study (January 2012-March 2013) included 1971 consecutive patients [male/female (M/F), 1158/813, 57.5 ± 11.9 years] who visited a single institute for annual health checkups. Transnasal EGD was performed in 1394 patients and transoral EGD in 577. EGD-associated discomfort was assessed using a visual analog scale score (VAS score: 0-10).
  
  
  RESULTS
  Multivariate analysis revealed gender (M vs F: 4.02 ± 2.15 vs 5.06 ± 2.43) as the only independent predictor of the VAS score in 180 patients who underwent EGD for the first time; whereas it revealed gender (M vs F 3.60 ± 2.20 vs 4.84 ± 2.37), operator, age group (A: < 39 years; B: 40-49 years; C: 50-59 years; D: 60-69 years; E: > 70 years; A/B/C/D/E: 4.99 ± 2.32/4.34 ± 2.49/4.19 ± 2.31/3.99 ± 2.27/3.63 ± 2.31), and type of insertion as independent predictors in the remaining patients. Subanalysis for gender, age group, and insertion route revealed that the VAS score decreased with age regardless of gender and insertion route, was high in female patients regardless of age and insertion route, and was low in males aged over 60 years who underwent transoral insertion.
  
  
  CONCLUSIONS
  Although comprehensive analysis revealed that the insertion route may not be an independent predictor of the VAS score, transoral insertion may reduce EGD-associated discomfort in elderly patients.
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ono
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Niimi
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sakaguchi
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Chiemi
authors.initials: C
authors.lastname: Nakayama
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Minatsuki
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Matsuda
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Itsuko
authors.initials: I
authors.lastname: Hirayama-Asada
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tsuji
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mochizuki
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kodashima
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Nobutake
authors.initials: N
authors.lastname: Yamamichi
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Ozeki
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Lumine
authors.initials: L
authors.lastname: Matsumoto
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Ohike
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yamazaki
authors.affiliation: Satoshi Ono, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D020776:Endoscopes, Gastrointestinal; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D057240:Patient Preference; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires
keywords: Esophagogastroduodenoscopy; Ultrathin endoscope; Visual analog scale