Identification of factors that influence tolerance of upper gastrointestinal endoscopy

Objective Unsedated gastroscopy is unpleasant for some patients, The identi fication of factors related to tolerance would permit the selection of pati ents for sedation. The aim of the present study was to identify these facto rs. Methods Five hundred and nine patients underwent diagnostic gastroscopy aft er the administration of topical pharyngeal anaesthesia, without sedation. Patients were grouped as to whether they had undergone prior examinations o r not. Tolerance was assessed with a visual analogue scale and a questionna ire. Results Two hundred and seventy-three (54%) patients underwent gastroscopy for the first time, and 236 (46%) patients had prior experience. Patient to lerance was poor in 84 of 273 (31%) patients undergoing gastroscopy for the first time, and in 61 of 236 (26%) patients with prior experience. Logisti c regression analysis identified the following variables related to poor to lerance: (a) in patients undergoing gastroscopy for the first time: presenc e of gag reflex (odds ratio (OR) = 3.42, 95% confidence interval (Cl) 1.90- 6.17), apprehension (OR = 2.57, Cl 1.33-4.95), young age (OR = 0.95, Cl 0.9 3-0.98) and high level of anxiety (OR = 1.91, Cl 0.96-3.89); (b) in patient s with prior experience: apprehension (OR = 4.21, Cl 1.93-9.20), poor toler ance of prior examinations (OR = 4.92, Cl 1.93-12.5) and female (OR = 2.23, Cl 1.09-4.57). Conclusions The above-mentioned factors are predictive of poor tolerance, a nd may enable the identification of those patients who might benefit more f rom sedation for gastroscopy. (C) 1999 Lippincott Williams & Wilkins.