A prospective controlled trial of an ultrathin versus a conventional endoscope in unsedated upper gastrointestinal endoscopy

Background and Study Aims: Upper gastrointestinal endoscopy is performed wi thout sedation in many countries. Unsedated patients experience more discom fort during endoscopy than sedated patients, but few studies have examined factors which could be modified to minimize discomfort during the procedure . We assessed the effect of endoscope diameter on patient discomfort during unsedated transoral gastroscopy. Patients and Methods: A total of 322 patients attending for unsedated endos copy were examined using an endoscope of diameter either 6.0 mm or 9.8 mm. Patients completed a two-part questionnaire assessing tolerance of the proc edure and discomfort during it. Results: There was failure to complete the initial unsedated endoscopy in t hree of 163 patients in the 6.0 mm group and 14 of 159 in the 9.8 mm group (P = 0.009). Patients in the 6.0 mm group reported less discomfort both dur ing endoscope insertion (P<0.0001) and during the remainder of the procedur e (P<0.0001). 14% of patients in the 6.0mm group indicated that they would request sedation if a further endoscopy were necessary, compared with 31% i n the 9.8mm group (P = 0.0005). Conclusions: Ultrathin endoscopes may have a role in clinical practice if r andomized comparative studies with standard-bore instruments confirm that t hey do not compromise diagnostic quality.