Unsedated small-caliber esophagogastroduodenoscopy (EGD) versus conventional EGD: A comparative study

Background & Aims: Significant portions of-the cost and complications of es ophagogastroduodenoscopy (EGD) are related to sedation, This study aimed to assess the feasibility, acceptability, and accuracy of unsedated small-cal iber transoral EGD (sc-EGD), Methods: A 4-phase study was performed in heal thy volunteers and patients. Phases 1 and 2 involved assessment of the tech nical feasibility of sedated sc-EGD and the tolerability of unsedated sc-EG D, respectively, in volunteers. Subsequently, the technical feasibility, to lerability, and diagnostic accuracy of sedated and unsedated sc-EGD were de termined by having each patient undergo sc-EGD (Pentax EG-1840) with (phase 3) and without (phase 4) sedation, followed by sedated conventional EGD (c -EGD) (Olympus GIF-100 or GIF-Q140) by a staff endoscopist blinded to the f indings of the sc-EGD, The t test for paired samples was used for statistic al analysis, A P value of < 0.05 was considered significant. Results: Sedat ed and unsedated sc-EGD were technically feasible and tolerable in all volu nteers. In patients, compared with sedated c-EGD, sedated and unsedated sc- EGD were 96% and 97% accurate, respectively. The overall acceptability of u nsedated sc-EGD was only slightly worse than that of sedated c-EGD (median, 2 vs. 1 on a scale of 1-10), After unsedated sc-EGD, 98% of patients expre ssed willingness to undergo the procedure again, No complications were obse rved during any phase of the study. Conclusions: Unsedated sc-EGD is techni cally feasible, tolerable, and accurate, It can potentially decrease the co sts and complications of sedated conventional EGD.