A randomized trial of peroral versus transnasal unsedated endoscopy using an ultrathin videoendoscope

Background: Potential advantages of unsedated endoscopy include the prevent ion of side effects or morbidity related to the use of sedative drugs, less intensive patient monitoring, and less expense. We compared transnasal (T- EGD) with peroral (P-EGD) unsedated endoscopy by using an ultrathin video i nstrument with respect to patient tolerance and acceptance. Method: Patients were randomized to T-EGD or P-EGD. If the initial route of insertion failed, the patient was crossed over to the other route. If this also failed, the patient underwent endoscopy under conscious sedation with an ultrathin instrument. A questionnaire for tolerance was completed by th e patient (a validated 0-10 scale where "0" represents none/well tolerated and "10" represents severe/poorly tolerated). Results: Of 105 recruited patients, 60 consented to undergo unsedated endos copy. There were 20 men and 11 women (mean age 45 years) in the P-EGD group and 15 men and 14 women (mean age 48 years) in the T-EGD group. Of 35 tota l P-EGD patients (4 were crossed over T-EGD patients), 34 (97%) completed a n unsedated examination. Of 29 T-EGD patients, 25 (86%) had a complete exam ination. Three T-EGD examinations failed for anatomical reasons; all 3 pati ents when crossed over to the P-EGD route had a successful examination. One patient was unable to tolerate either route. Between the P-EGD and the T-E GD groups, pre-procedure anxiety (3.6 +/- 0.5 vs. 3.0 +/- 0.6), discomfort during insertion (2.1 +/- 0.5 vs. 3.3 +/- 0.7), gagging (4.7 +/- 0.5 vs. 3. 2 +/- 0.6), and overall tolerance (2.4 +/- 0.5 vs. 3.8 +/- 0.7) were simila r (p > 0.05). However, discomfort on insertion was significantly greater in the T-EGD versus the P-EGD group (4.4 +/- 0.6 vs. 2.7 +/- 0.5: p < 0.05). Eighty-nine percent of P-EGD patients and 69% of T-EGD patients, p = 0.07, were willing to undergo unsedated endoscopy in the future. Conclusion T-EGD patients experienced significantly more pain on insertion than did P-EGD patients. Otherwise, unsedated endoscopy by either the trans nasal or the peroral route is generally well tolerated. In this study it wa s completed in 59 of 60 patients.