Published online Jul 16, 2013. doi: 10.4253/wjge.v5.i7.346
Revised: April 27, 2013
Accepted: June 18, 2013
Published online: July 16, 2013
AIM: To evaluate the effects of choice of insertion route and ultrathin endoscope types.
METHODS: This prospective study (January-June 2012) included 882 consecutive patients who underwent annual health checkups. Transnasal esophagogastroduodenoscopy (EGD) was performed in 503 patients and transoral EGD in 235 patients using six types of ultrathin endoscopes. Patients were given a choice of insertion route, either transoral or transnasal, prior to EGD examination. For transoral insertion, the endoscope was equipped with a thin-type mouthpiece and tongue depressor. Conscious sedation was not used for any patient. EGD-associated discomfort was assessed using a visual analog scale (VAS; no discomfort 0- maximum discomfort 10).
RESULTS: Rates of preference for transnasal insertion were significantly higher in male (male/female 299/204 vs 118/117) and younger patients (56.8 ± 11.2 years vs 61.3 ± 13.0 years), although no significant difference was found in VAS scores between transoral and transnasal insertion (3.9 ± 2.3 vs 4.1 ± 2.5). Multivariate analysis revealed that gender, age, operator, and endoscope were independent significant predictors of VAS for transnasal insertion, although gender, age, and endoscope were those for transoral insertion. Further analysis revealed only the endoscopic flexibility index (EFI) as an independent significant predictor of VAS for transnasal insertion. Both EFI and tip diameter were independent significant predictors of VAS for transoral insertion.
CONCLUSION: Flexibility of ultrathin endoscopes can be a predictor of EGD-associated discomfort, especially in transnasal insertion.
Core tip: To evaluate the effects of choice of insertion route and ultrathin endoscope types for unsedated surveillance esophagogastroduodenoscopy (EGD), this prospective study was conducted including 882 consecutive patients who underwent annual health checkup using six types of ultrathin endoscopes in a single institute. EGD-associated discomfort was assessed using a visual analog scale (VAS) by patients themselves. Statistical analysis of VAS revealed the following two points; Transnasal insertion of ultrathin endoscopy for unsedated EGD can be preferable for younger males rather than elder females. Flexibility of ultrathin endoscopes can be a reliable predictor of reduction in transnasal EGD-associated discomfort rather than thinness of tip.