Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2020; 12(4): 128-137
Published online Apr 16, 2020. doi: 10.4253/wjge.v12.i4.128
Causative factors of discomfort in esophagogastroduodenoscopy: A large-scale cross-sectional study
Kenichiro Majima, Takeshi Shimamoto, Yosuke Muraki
Kenichiro Majima, Yosuke Muraki, The Department of Health Management, Kameda Medical Center, Kamogawa City 296-8602, Chiba Prefecture, Japan
Takeshi Shimamoto, The Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Chiba City 261-7114, Chiba Prefecture, Japan
Author contributions: Majima K contributed to the study design, acquisition, analysis and interpretation of the data; the writing, editing, reviewing, and final approval of the article; Shimamoto T contributed to the study design, data analysis and interpretation, reviewing and final approval of the article; Muraki Y contributed to the study design, acquisition and interpretation of the data, the editing, reviewing, and final approval of the article.
Institutional review board statement: This study was reviewed and approved by the Kameda Medical Center Institutional Review Board.
Informed consent statement: Since this was a retrospective observational study using existing data and did not include invasive interventions, the requirement for informed consent from the study participants was waived by the Institutional Review Board.
Conflict-of-interest statement: The authors have no conflicts of interest to declare for this article.
Data sharing statement: Dataset and statistical methods are available from the first author at majima.kenichiro@kameda.jp.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kenichiro Majima, MD, Doctor, The Department of Health Management, Kameda Medical Center, 929 Higashi-cho, Kamogawa City 296-8602, Chiba Prefecture, Japan. majima.kenichiro@kameda.jp
Received: December 28, 2019
Peer-review started: December 28, 2019
First decision: January 13, 2020
Revised: January 24, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 16, 2020
ARTICLE HIGHLIGHTS
Research background

Discomfort due to esophagogastroduodenoscopy contributes to a negative experience and reduces the patients’ satisfaction. Therefore, it is important to reduce discomfort as much as possible. By identifying the factors that cause discomfort, we can take remedial measures such as using sedation.

Research motivation

However, not all factors of discomfort have been elucidated yet. Most previous studies have conducted investigations only in several hundred subjects, which is a relatively small sample.

Research objectives

The aim of this study was to elucidate the contributing factors of discomfort in transoral esophagogastroduodenoscopy by a large-scale cross-sectional study.

Research methods

This study was a retrospective observational study using a questionnaire for the improvement of hospital services. Discomfort was evaluated using a face scale between 0 and 10 with a 6-level questionnaire. Univariate and multiple regression analyses were performed to investigate the factors related to the discomfort in esophagogastroduodenoscopy. The primary outcome was the result of a multiple regression. In this analysis, the objective variable was the discomfort score and the explanatory variables were age, sex, height, body mass index, smoking status, alcohol intake, hiatal hernia, history of gastrectomy, biopsy during examination, Lugol’s solution usage, administration of butylscopolamine with/without a sedative (pethidine, midazolam, or both), endoscope model, history of endoscopy, and endoscopists.

Research results

Finally, 1715 patients were enrolled in this study. Based on multiple regression analysis, young age, female sex, shorter height, current smoking status, and presence of hiatal hernia [regression coefficients of 0.08, P < 0.001 (for -1 years); 0.45, P = 0.013; 0.02, P = 0.024 (for -1 cm); 0.35, P = 0.036; and 0.34, P = 0.003, respectively] were factors that significantly increased the discomfort in esophagogastroduodenoscopy. Alternatively, sedation significantly reduced discomfort; pethidine (regression coefficient: -1.47, P < 0.001) and midazolam (regression coefficient: -1.63, P = 0.001) both individually and in combination (regression coefficient: -2.92, P < 0.001) significantly reduced the discomfort. A difference in the endoscopist performing the procedure was also associated with discomfort. Additionally, for the proportion of a high discomfort level (score ≥ 6) in the sedated group, significant differences were also found based on alcohol intake in univariate analyses (P = 0.001).

Research conclusions

The present study clearly identified the factors associated with discomfort in esophagogastroduodenoscopy using a large-size cross-sectional study. Young age, female sex, and current smoking were identified as the contributive factors. Smoking status was a newly identified predictor of this study. Furthermore, heavy alcohol consumption was noted to diminish the effect of the sedative(s). These factors are useful because they can be easily obtained, and we can take remedial measures for reducing discomfort.

Research perspectives

Prospective research is needed to clarify whether predicting discomfort and taking measures to alleviate it can effectively increase patient satisfaction.