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Arterial oxygen desaturation during oesophago-gastro duodenoscopy (OGD) is well recognised. It has been suggested that severe desaturation (greater than 7%) may predispose patients with cardiopulmonary disease and the elderly to cardiac arrhythmias. During OGD, of 106 elderly patients 26 developed ventricular and/or supraventricular ectopics, but t...
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... this study 114 7(39%) changes in oxygen saturation from baseline were significantly different between the two groups at all stages during the examination (Table 2) (29) 10 (21) performing OGD in the majority of patients. Diagnoses which influenced management were found in 75% of patients, while no abnormalities were recorded in 25% of patients (Table 4). ...Citations
... In western countries, this procedure is often performed with patient under conscious sedation, to reduce agitation resulting from discomfort and pain. 1 However, sedation may increase the costs and cause additional cardiopulmonary complications. 1,2 Many efforts have therefore been made to improve feasibility and the tolerance of unsedated endoscopy. 3e5 In addition, new smallcaliber video endoscopes (with diameter 5e6 mm) have been developed to facilitate peroral (PO) and transnasal (TN) endoscopy for the upper gastrointestinal tract without sedation. ...
Differences in patient tolerance, acceptance, and satisfaction of esophagogastroduodenoscopy (EGD) between transnasal (TN) and peroral (PO) routes using a 5-mm video endoscope.
A total of 220 enrolled patients were assigned randomly to two groups undergoing EGD-110 patients each for TN and PO. The successful rate, procedure time, and adverse events were recorded. After the procedure, patients answered a validated questionnaire of tolerance, acceptance, and satisfaction.
There were 6 failures (5.7%) of nasal intubation and two nasal bleeding (2%) among 105 TN-EGD procedures. All PO patients (n=102) completed EGD successfully without adverse event. Compared to PO, the procedure of TN achieved lower successful rate (94% vs. 100%, p=0.01), was complicated with epistaxis (2% vs. 0%) and took longer (mean±SD 19.9±6.1min vs. 16.8±6.4min, p=0.0001). The patients undergoing TN-EGD indicated less discomfort during passing pharynx (scores of 2.1±2.0 vs. 3.1±2.6, p=0.011) but more pain during inserting scope (scores of 2.2±1.6 vs. 1.5±1.8, p=0.0001). Eventually, there were no significant differences between TN and PO regarding the overall procedure discomfort (scores of 10.7±6.6 vs. 11.1±7.8 scores, p=0.9), satisfaction (scores of 41.2±4.2 vs. 41.3±4.6, p=0.91), and acceptability (87.8% vs. 94.2%, p=0.91).
PO intubation seems an excellent alternative method when using a 5-mm ultrathin endoscopy because it achieves comparable patient tolerance, acceptance, and satisfaction as TN intubation, takes less time and causes lower intubation failure and epistaxis.
... In this context, not only the increasing longevity but also the improvement in performance status must be considered. In the past, there has been a reluctance to consider older patients for noncritical endoscopic interventions, because of the perceived drop in safety and tolerance as well as lack of substantive benefits2345. While some trials had already addressed the safety of performing endoscopic retrograde cholangio-pancreatography (ERCP) in elderly patients [6, 7] in a retrospective study design, in our trial we included the largest number of patients over 80 years published so far in a prospective study design. ...
... The impact of endoscope diameter and the presence of systemic sedation on cardiopul- AJG -Vol. 98, No. 11, 2003 monary risk have been evaluated by different authors (11,(15)(16)(17). Lieberman et al. (15) assigned patients to three different groups: 8.5-mm endoscope with no sedation (group 1), 8.5-mm endoscope with diazepam (group 2), and 11.5-mm endoscope with diazepam (group 3). ...
A more widely available, well-tolerated, and cost-effective technique is needed to screen a broad population at risk for esophageal cancer. An ideal solution might be to perform unsedated esophagoscopy with an entirely self-contained, small-caliber endoscope. In a prospective, blinded study in three phases, we compared the feasibility, patient tolerance, and diagnostic accuracy of esophagoscopy performed with a prototype, superthin, battery-powered esophagoscope (BPE) with standard video esophagogastroduodenoscopy (SVE).
In phase I, 10 healthy volunteers underwent both peroral and transnasal esophagoscopy with BPE to evaluate the technical feasibility of the examination. For phases II and III, patients were recruited to have BPE before SVE. In phase II, both procedures were performed with conscious sedation. In phase III, the BPE was performed with only topical anesthesia. Two endoscopists assessed the technical performance of the endoscope and patient tolerance and recorded the esophageal findings independently.
In phase I, all endoscopists reported adequate visualization of the esophagus in the 10 volunteers. A total of 181 patients were evaluated in phases II and III (89 in phase II, 92 in phase III). The sensitivity for detecting columnar lined esophagus was 94% in phase II and 95% in phase III. The sensitivity for all esophageal findings was 87% and 86% in phases II and III, respectively. The technical performance of the endoscope was significantly worse for BPE compared with the SVE. The patient tolerance as evaluated by the endoscopist was similar for both procedures. Ninety-five percent of the patients undergoing unsedated BPE were willing to have the procedure repeated under similar circumstances.
Unsedated esophagoscopy with a 3.1-mm, battery-powered, stand-alone esophagoscope is feasible, well tolerated, and accurate in detecting esophageal pathologies. It might be an efficient and cost-effective screening tool for the detection of columnar lined esophagus.
... Elderly patients and individuals with underlying cardiopulmonary disease are at a greater risk. [5][6][7][8][9] Furthermore, the use of sedation requires physiological monitoring and, at some centers, anesthesia participation. 5 Sedation also results in increased loss of work on the day of endoscopy 7 and the need for a person to accompany the patient home after the procedure. ...
... 7,8,[10][11][12][13][14][15][16][17][18] Although EGD is a safe procedure, complications can occur, especially in elderly patients with underlying cardiac or pulmonary disease. [5][6][7][8][9] Sedated endoscopy has traditionally been performed in an endoscopy unit, whereas unsedated endoscopy can be conveniently performed as an outpatient procedure in any setting. Unsedated endoscopy offers cost-effective incentives. ...
Significant portions of the cost and complications of esophagogastroduodenoscopy (EGD) are related to sedation. This study aimed to assess the feasibility, acceptability, and accuracy of unsedated small-caliber transoral EGD (sc-EGD).
A 4-phase study was performed in healthy volunteers and patients. Phases 1 and 2 involved assessment of the technical feasibility of sedated sc-EGD and the tolerability of unsedated sc-EGD, respectively, in volunteers. Subsequently, the technical feasibility, tolerability, and diagnostic accuracy of sedated and unsedated sc-EGD were determined by having each patient undergo sc-EGD (Pentax EG-1840) with (phase 3) and without (phase 4) sedation, followed by sedated conventional EGD (c-EGD) (Olympus GIF-100 or GIF-Q140) by a staff endoscopist blinded to the findings of the sc-EGD. The t test for paired samples was used for statistical analysis. A P value of <0.05 was considered significant.
Sedated and unsedated sc-EGD were technically feasible and tolerable in all volunteers. In patients, compared with sedated c-EGD, sedated and unsedated sc-EGD were 96% and 97% accurate, respectively. The overall acceptability of unsedated sc-EGD was only slightly worse than that of sedated c-EGD (median, 2 vs. 1 on a scale of 1-10). After unsedated sc-EGD, 98% of patients expressed willingness to undergo the procedure again. No complications were observed during any phase of the study.
Unsedated sc-EGD is technically feasible, tolerable, and accurate. It can potentially decrease the costs and complications of sedated conventional EGD.
... Patients with ischaemic heart disease, stroke, gastrointestinal bleeding and anaemia are considered to be at risk, as are the elderly. They should be given little or no sedation and carefully monitored during the procedure [3,4]. The overall feasibility and acceptance of OGD in the elderly without sedation need to be evaluated further as it could potentially increase the number of patients examined as day cases. ...
... The examination was undertaken in the left lateral position. At baseline, during, at extubation and five minutes after OGD, blood pressure, oxygen saturation and cardiac rhythm were recorded as previously described [4]. ...
The cardiopulmonary complications associated with gastroscopy could be reduced by giving little or no prior sedation. The ability to tolerate the procedure with and without sedation was compared in 62 elderly patients by recording responses to a questionnaire designed to evaluate the patient's own assessment of the examination. A similar percentage of sedated and unsedated patients described the procedure as mildly unpleasant (63% vs 57%; chi 2 = 0.500; p > 0.10). The majority (73%) of unsedated patients did not want to be sedated for future examinations because of the inconvenience of the recovery period. Elderly patients should therefore be given the choice of undergoing the procedure without sedation. Full counselling and explanation of the procedure are however even more important to allay anxiety and apprehension if the procedure is undertaken without sedation.
Objective: To assess the effects of endoscopy in ischaemic heart disease patients with special reference to oxygen saturation, blood pressure, cardiac rhythm, lignocaine level and the relation of serum lignocaine and oxygen saturation on cardiac events. Study: A prospective, matched, case-control study. Place and Duration of Study: Department of Medicine, Dow Medical College, and Civil Hospital, Karachi, over a period of 6 months Patients and Methods: Sixty cases selected for endoscopy with dyspeptic symptoms were divided into two groups (30 in each group). Study group comprised of ischaemic heart disease (IHD) patients and control group without IHD patients. Information regarding occupation, cardiorespiratory illness, addiction, medication etc., was obtained on a specially designed proforma and relevant investigations were carried out. Their pre-endoscopy oxygen saturation, cardiac rhythm and blood pressure were noted and monitored during and after the procedure till the changes that have taken place during procedure were returned back to their baseline level. At the end, blood sample was drawn for lignocaine level estimation. Results: Lignocaine levels remained in safe range in all patients but oxygen saturation dropped in IHD patients (10%) and they developed cardiac rhythm changes e.g., tachycardia and premature ventricular contraction (6.7%) and ST segment elevation (3.3%). Conclusion: Cardiac events in IHD patients can occur during the endoscopy, therefore, these patients should be monitored for oxygen saturation and supplementation. Lignocaine oropharyngeal gargles is the safe method of local anesthesia for upper GI endoscopy.
Gastrointestinal complaints are frequent in elderly patients, and GI endoscopy plays an important diagnostic role in the evaluation of these complaints. Endoscopy is safe in the aged. Therapeutic applications of endoscopy are increasingly being used in the management of a wide variety of GI diseases in the elderly.
A more widely available, well-tolerated, and cost-effective technique is needed to screen a broad population at risk for esophageal cancer. An ideal solution might be to perform unsedated esophagoscopy with an entirely self-contained, small-caliber endoscope. In a prospective, blinded study in three phases, we compared the feasibility, patient tolerance, and diagnostic accuracy of esophagoscopy performed with a prototype, superthin, battery-powered esophagoscope (BPE) with standard video esophagogastroduodenoscopy (SVE).
Purpose. - In case of unexplained weight loss, chest X-ray, abdominal ultrasonography and gastroscopy are usually recommended. However, gastroscopy is not usually performed in elderly patients. Methods. - We evaluated 77 patients (mean age: 80 +/- 8 years) hospitalized in our geriatric unit between January 1995 and May 1997 for unexplained weight loss. All patients underwent chest X-ray, abdominal ultrasonography and gastroscopy. Results. - These investigations led to diagnosis in respectively 17, 15 and 46 patients. The etiology of weight loss was unique in 47 patients, while in 30 other patients at least two or three causes could be described. Gastroscopy appeared to be the most useful test, as it allowed description of eight cases of cancer, 29 cases of peptic ulcer, two cases of candidosis, and one case of actinomycosis in patients who did not present any clinical sign. Conclusion. - Sixty-five patients were followed-up for a mean period of 13 +/- 21 month; 33 patients died. The condition of 23 patients improved either slightly or definitely. Simple investigations led to diagnosis in 95% of the cases. However, 42% of the patients died within 3 months. Gastroscopy appears to be the most valuable test leading to diagnosis in more than half of the cases. With adapted treatment, the condition of 75% of the patients with gastro-intestinal lesions improved. (C) 2001 Editions scientifiques et medicales Elsevier SAS.
