Brief Article
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World J Gastroenterol. May 7, 2014; 20(17): 5045-5050
Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.5045
Evaluation of preferable insertion routes for esophagogastroduodenoscopy using ultrathin endoscopes
Satoshi Ono, Keiko Niimi, Mitsuhiro Fujishiro, Yu Takahashi, Yoshiki Sakaguchi, Chiemi Nakayama, Chihiro Minatsuki, Rie Matsuda, Itsuko Hirayama-Asada, Yosuke Tsuji, Satoshi Mochizuki, Shinya Kodashima, Nobutake Yamamichi, Atsuko Ozeki, Lumine Matsumoto, Yumiko Ohike, Tsutomu Yamazaki, Kazuhiko Koike
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
Keiko Niimi, Mitsuhiro Fujishiro, Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
Satoshi Ono, Keiko Niimi, Mitsuhiro Fujishiro, Yu Takahashi, Yoshiki Sakaguchi, Chiemi Nakayama, Chihiro Minatsuki, Rie Matsuda, Itsuko Hirayama-Asada, Yosuke Tsuji, Satoshi Mochizuki, Shinya Kodashima, Nobutake Yamamichi, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
Author contributions: Ono S, Niimi K and Fujishiro M designed the study protocol and analyzed the data; Ono S drafted the article; Niimi K, Fujishiro M, Takahashi Y, Sakaguchi Y, Nakayama C, Minatsuki C, Matsuda R, Hirayama-Asada I, Tsuji Y, Mochizuki S, Kodashima S, Yamamichi N, Ozeki A, Matsumoto L and Ohike Y made critical revisions of the article for important intellectual content; Yamazaki T and Koike K made final approval of the article.
Supported by Grant-in-Aid for Young Scientists (B) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT)
Correspondence to: Satoshi Ono, MD, PhD, Assistant professor, Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. satoshi-tky@umin.ac.jp
Telephone: +81-3-38155411 Fax: +81-3-58008806
Received: September 20, 2013
Revised: December 13, 2013
Accepted: January 19, 2014
Published online: May 7, 2014
Processing time: 231 Days and 19.2 Hours
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Esophagogastroduodenoscopy; Ultrathin endoscope; Visual analog scale

Core tip: To evaluate the effects of insertion route for unsedated surveillance esophagogastroduodenoscopy (EGD), this retrospective study included 1971 consecutive patients who visited a single institute for annual health checkups. EGD-associated discomfort was assessed using a visual analog scale (VAS). Statistical analysis using VAS revealed that the VAS score decreased with age regardless of gender and insertion route, was high in females regardless of age and insertion route, and was low in males aged over 60 years who underwent transoral insertion.