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Unsedated Peroral Endoscopy With a Video Ultrathin Endoscope: Patient Acceptance, Tolerance, and Diagnostic Accuracy

Zaman, Atif, MD1; Hapke, Ronald, MD1; Sahagun, Geronimo, MD1; Katon, RonaldM, MD1, *

American Journal of Gastroenterology: August 1998 - Volume 93 - Issue 8 - p 1260–1263
doi: 10.1111/j.1572-0241.1998.00406.x
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Objective: The aim of this study was to assess patient tolerance of unsedated routine upper endoscopy using a 6-mm ultrathin (UT) video endoscope (Olympus XGIF-N200H) and to compare its optical quality to a standard endoscope (Olympus GIF100).

Methods: A total of 62 outpatients were recruited for unsedated UT endoscopy using topical spray followed by sedated endoscopy using a standard endoscope. After unsedated endoscopy, patients were asked to complete a questionnaire assessing tolerance. When both endoscopies were completed, the endoscopist recorded findings and optical quality of the UT.

Results: Of 62 patients, 19 refused unsedated endoscopy because of anxiety (12), fear of gagging (3), and unwillingness to be study patients (4).Tolerance:Of 43 patients, 37 (86%) had a complete, unsedated UT exam (five patients did not have a GIF100 exam). During insertion, 60% of the patients reported none/mild discomfort, whereas, during the remainder of the examination, 73% had none/mild discomfort. Of 37 patients, 30 (81%) were willing to undergo future unsedated endoscopy with the UT and they tolerated UT endoscopy better than the patients who were unwilling (none/mild discomfort: 83%vs29%). Of 43 patients, six (14%) failed UT endoscopy because of severe gagging (all were male, mean age 44 yr).Optics:Optical quality was rated as good 84%, 65%, and 78% of the time in the esophagus, stomach, and duodenum, respectively. Optical quality was diminished by excessive fluid and tenacious secretions. The UT missed five of 59 lesions: three hiatal hernias and two gastric erosions.

Conclusion: A total of 69% of outpatients agreed to undergo peroral unsedated endoscopy with a UT endoscope. A total of 86% of patients tolerated a complete unsedated examination, and 81% of these were willing to undergo future unsedated examinations. Diagnostic accuracy of this ultrathin video endoscope was good, with 92% of lesions discovered when compared with a standard instrument.

1 Department of Medicine, Division of Gastroenterology, Oregon Health Sciences University, Portland, Oregon USA

* Division of Gastroenterology, PV-310, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97210

Received November 06, 1997; accepted April 27, 1998.

© The American College of Gastroenterology 1998. All Rights Reserved.
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