Negative impact of sedation on esophagogastric junction evaluation during esophagogastroduodenoscopy

Table 1 Baseline characteristics of subjects n (%)

	No sedation	Midazolam	Propofol	P value
	(n = 35)	(n = 35)	(n = 33)
Age, yr	61 ± 9.2	57.5 ± 10.5	56.5 ± 10.9	0.132
Male	17 (48.6)	21 (60.0)	12 (36.4)	0.152
Weight, kg	60.6 ± 9.2	52.5 ± 8.9	63.5 ± 12.4	0.506
Height, cm	161.5 ± 6.7	163.2 ± 9.9	160.3 ± 8.1	0.340
Abdomen, cm	81.8 ± 10.0	85.8 ± 7.5	84.8 ± 10.6	0.194
Hip, cm	92.7 ± 5.8	94.4 ± 6.1	95.1 ± 6.3	0.260
BMI	23.2 ± 3.0	23.44 ± 2.6	24.5 ± 3.1	0.143
Comorbidity
Hypertension	10 (28.6)	7 (20.0)	9 (27.3)	0.717
Diabetes mellitus	2 (5.7)	5 (14.3)	8 (24.2)	0.103
Cardiovascular accident	1 (2.9)	1 (2.9)	1 (3.0)	1.000
Ischemic heart disease	2 (5.7)	0 (0.0)	2 (6.1)	0.277
Liver disease	2 (5.7)	1 (2.9)	2 (6.1)	0.867
Malignancy	1 (2.9)	2 (5.7)	0 (0.0)	0.771

BMI: Body mass index.

Table 2 Endoscopy-related outcomes among the groups n (%)

	No sedation	Midazolam	Propofol	P value
	(n = 35)	(n = 35)	(n = 33)
Indications				0.084
Screening	28 (80.0)	25 (71.4)	17 (51.5)
Epigastric discomfort/pain	5 (14.3)	6 (17.2)	14 (42.6)
Peptic ulcer disease follow-up	1 (2.9)	1 (2.9)	2 (6.0)
Others	1 (2.9)	3 (8.6)	0 (0.0)
Endoscopic findings
Reflux esophagitis	4 (11.4)	2 (5.7)	2 (6.1)	0.726
Hiatal hernia	0 (0.0)	3 (8.6)	0 (0.0)	0.105
Peptic ulcer disease	3 (8.6)	2 (5.7)	2 (6.1)	1.000
Gastric polyp	2 (5.7)	2 (5.7)	1 (3.0)	1.000
Neoplasm	0 (0.0)	2 (5.7)	0 (0.0)	0.327
Adverse event
Hiccoughing	0 (0.0)	9 (25.7)	3 (90.0)	0.002
Hypoxia	0 (0.0)	0 (0.0)	2 (6.1)	0.101

Table 3 Extent of observed esophagogastric junction territory during insertion n (%)

	No sedation	Midazolam	Propofol	P value
Observation time	11.6 ± 5.8	16.3 ± 7.3	20.7 ± 11.7	< 0.001
Observed EGJ territory				< 0.001
Excellent	32 (91.4)	10 (28.6)	9 (27.3)
Good	1 (2.9)	13 (37.3)	12 (36.4)
Fair	1 (2.9)	11 (31.4)	11 (33.3)
Poor	1 (2.9)	1 (2.9)	1 (3.0)

EGJ: Esophagogastric junction.

Table 4 Changes in observed esophagogastric junction territory during withdrawal in patients with non-excellent territory during insertion (n = 52) n (%)

	No sedation	Midazolam	Propofol	P = 0.291
	(n = 3)	(n = 25)	(n = 24)
Extended	1 (33.3)	5 (20)	6 (25)
Same	2 (66.7)	10 (40)	10 (41.7)
Reduced	0	10 (40)	8 (33.3)

Table 5 Univariate analysis of factors associated with non-excellent observation of esophagogastric junction territory

	Excellent	Non-excellent	P value
	(n = 51)	(n = 52)
Age, yr	59.39 ± 9.5	57.5 ± 11.1	0.355
Male	11 (21.6)	23 (44.2)	0.377
Weight, kg	61.29 ± 8.8	63.05 ± 11.5	0.384
Height, cm	161.29 ± 7.7	161.37 ± 9.6	0.706
BMI	23.33 ± 2.8	24.10 ± 3.1	0.185
Abdomen, cm	82.97 ± 9.5	85.27 ± 9.4	0.221
Hip, cm	92.98 ± 5.5	95.14 ± 6.5	0.073
HW ratio	0.89 ± 0.06	0.89 ± 0.05	0.704
Comorbidity
Hypertension	11 (21.6)	15 (28.8)	0.395
Diabetes mellitus	4 (7.8)	11 (21.2)	0.057
Cardiovascular accident	2 (3.9)	1 (1.9)	0.548
Ischemic heart disease	2 (3.9)	3 (5.8)	0.664
Liver disease	2 (3.9)	3 (5.8)	0.664
Sedation			< 0.001
No	32 (62.7)	3 (5.8)
Midazolam	10 (19.6)	25 (48.1)
Propofol	9 (17.6)	24 (43.2)

Data are expressed as absolute numbers (percentage) or mean ± SD. BMI: Body mass index.

Table 6 Multivariate analysis of factors associated with non-excellent observation of esophagogastric junction territory

Variables	OR	95%CI	P value
Hip	1.044	0.961-1.133	0.307
Diabetes mellitus	1.984	0.472-8.337	0.350
Sedation
No	1.000
Midazolam	25.316	6.217-103.088	< 0.001
Propofol	24.417	5.869-101.575	< 0.001