Negative impact of sedation on esophagogastric junction evaluation during esophagogastroduodenoscopy.
OBJECTIVE
To compare the esophagogastric junction (EGJ) areas observed in sedated and non-sedated patients during esophagogastroduodenoscopy (EGD).


METHODS
Data were collected prospectively from consecutive patients who underwent EGD for various reasons. The patients were divided into three groups according to the sedation used: propofol, midazolam, and control (no sedation). The EGJ was observed during both insertion and withdrawal of the endoscope. The extent of the EGJ territory observed was classified as excellent, good, fair, or poor. In addition, the time the EGJ was observed was estimated.


RESULTS
The study included 103 patients (50 males; mean age 58.44 ± 10.3 years). An excellent observation was achieved less often in the propofol and midazolam groups than in the controls (27.3%, 28.6% and 91.4%, respectively, P < 0.001). There was a significant difference in the time at which EGJ was observed among the groups (propofol 20.7 ± 11.7 s vs midazolam 16.3 ± 7.3 s vs control 11.6 ± 5.8 s, P < 0.001). Multivariate analysis showed that sedation use was the only independent risk factor for impaired EGJ evaluation (propofol, OR = 24.4, P < 0.001; midazolam, OR = 25.3, P < 0.001). Hiccoughing was more frequent in the midazolam group (propofol 9% vs midazolam 25.7% vs control 0%, P = 0.002), while hypoxia (SaO2 < 90%) tended to occur more often in the propofol group (propofol 6.1% vs midazolam 0% vs control 0%, P = 0.101).


CONCLUSIONS
Sedation during EGD has a negative effect on evaluation of the EGJ.
Eun Soo Kim, Ho Young Lee, Yoo Jin Lee, Bo Ram Min, Jae Hyuk Choi, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
Eun Soo
ES
Kim
Eun Soo Kim, Ho Young Lee, Yoo Jin Lee, Bo Ram Min, Jae Hyuk Choi, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
Ho Young
HY
Lee
Eun Soo Kim, Ho Young Lee, Yoo Jin Lee, Bo Ram Min, Jae Hyuk Choi, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
Yoo Jin
YJ
Lee
Eun Soo Kim, Ho Young Lee, Yoo Jin Lee, Bo Ram Min, Jae Hyuk Choi, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
Bo Ram
BR
Min
Eun Soo Kim, Ho Young Lee, Yoo Jin Lee, Bo Ram Min, Jae Hyuk Choi, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
Jae Hyuk
JH
Choi
Eun Soo Kim, Ho Young Lee, Yoo Jin Lee, Bo Ram Min, Jae Hyuk Choi, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
Kyung Sik
KS
Park
Eun Soo Kim, Ho Young Lee, Yoo Jin Lee, Bo Ram Min, Jae Hyuk Choi, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
Kwang Bum
KB
Cho
Eun Soo Kim, Ho Young Lee, Yoo Jin Lee, Bo Ram Min, Jae Hyuk Choi, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
Byoung Kuk
BK
Jang
Eun Soo Kim, Ho Young Lee, Yoo Jin Lee, Bo Ram Min, Jae Hyuk Choi, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
Woo Jin
WJ
Chung
Eun Soo Kim, Ho Young Lee, Yoo Jin Lee, Bo Ram Min, Jae Hyuk Choi, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
Jae Seok
JS
Hwang
D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D016145:Endoscopy, Digestive System; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008874:Midazolam / Q000009:adverse effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015742:Propofol / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol
Endoscopy; Esophagogastric junction; Esophagus; Midazolam; Propofol