title: Does anxiety or waiting time influence patients' tolerance of upper endoscopy?
abstract: OBJECTIVE
  Endoscopy is an essential and very commonly used procedure for the evaluation of a multitude of gastrointestinal symptoms. Although it is increasingly required, patients often wait on arrival at the endoscopy unit until they are called for the procedure. It is not clear whether or not this waiting time may have an impact on patient's tolerance during upper endoscopy. Our study attempts to address this.
  
  
  METHODS
  We studied consecutive outpatients who underwent endoscopy from September to December, 2013. Gender, age, body mass index (BMI), previous endoscopic experiences, antidepressant therapy, and the time interval between arrival at the endoscopy unit and the onset of examination was recorded. Anxiety before the procedure, pain, and discomfort were rated by a numeric rating scale (0 = no pain/discomfort encountered to 10 = extremely painful/uncomfortable).
  
  
  RESULTS
  One hundred and five consecutive outpatients (male = 52; mean age = 45.3 years; age range = 20-86 years) were included in the study. The mean BMI was 25 ± 4.8; mean waiting time from registration to the procedure was  172 min (time range = 30 - 375 mins). Mean patients' pre-examination anxiety level was 3 ± 3.84, mean discomfort score was 4.3 ± 3.09 and mean pain score was 3.4 ± 3.03. The level of pain and discomfort was significantly higher in patients with higher levels of pre-procedure anxiety. No differences were found in terms of anxiety, pain and discomfort among patients divided according to waiting time.
  
  
  CONCLUSIONS
  According to our data, waiting time does not have a significant impact on the perception of pain and discomfort related to the endoscopic procedure. On the other hand, high pre-procedural levels of anxiety were associated with a low tolerance. Further multicenter randomized trials are needed to clarify the impact of waiting time.
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pontone
authors.forename: Maya
authors.initials: M
authors.lastname: Tonda
authors.forename: Manuela
authors.initials: M
authors.lastname: Brighi
authors.forename: Matteo
authors.initials: M
authors.lastname: Florio
authors.forename: Daniele
authors.initials: D
authors.lastname: Pironi
authors.forename: Paolo
authors.initials: P
authors.lastname: Pontone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology / Q000523:psychology*; D016099:Endoscopy, Gastrointestinal / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D012189:Retrospective Studies; D055815:Young Adult
references.citation: Am J Gastroenterol. 2006 Apr;101(4):866-72
references.pmid: 16635230
references.citation: Dig Dis Sci. 2013 May;58(5):1313-21
references.pmid: 23250673
references.citation: Gastrointest Endosc. 2009 Apr;69(4):883-91, quiz 891.e1
references.pmid: 19152911
references.citation: J Clin Nurs. 2005 Aug;14(7):798-804
references.pmid: 16000093
references.citation: Gastrointest Endosc. 2001 Jun;53(7):703-10
references.pmid: 11375575
references.citation: BMC Surg. 2012;12 Suppl 1:S11
references.pmid: 23173721
references.citation: Arch Med Res. 2004 Jan-Feb;35(1):43-8
references.pmid: 15036799
references.citation: Am J Gastroenterol. 2007 Nov;102(11):2401-10
references.pmid: 17608779
references.citation: Acad Emerg Med. 2003 Apr;10(4):390-2
references.pmid: 12670856
references.citation: Dig Dis. 2008;26(1):75-9
references.pmid: 18600020
references.citation: Dig Dis Sci. 2005 Oct;50(10):1860-71
references.pmid: 16187188
references.citation: Eur J Gastroenterol Hepatol. 2007 Oct;19(10):896-900
references.pmid: 17873615
references.citation: Korean J Fam Med. 2012 Jul;33(4):219-28
references.pmid: 22916324
references.citation: Endoscopy. 2007 Apr;39(4):345-9
references.pmid: 17285514
references.citation: BMC Gastroenterol. 2012;12:96
references.pmid: 22839572
references.citation: Scand J Gastroenterol. 2001 Dec;36(12):1352-7
references.pmid: 11761029
references.citation: Can J Gastroenterol. 2013;27(5):259-66
references.pmid: 23712300
references.citation: Gastroenterol Res Pract. 2012;2012:561893
references.pmid: 22606201