Factors associated with tolerance to, and discomfort with, unsedated diagnostic gastroscopy

Background: Identification of patients likely to experience high levels of discomfort during unsedated gastroscopy would be useful as these patients c ould be prospectively targeted for sedation. We prospectively assessed pati ent and endoscopic variables in subjects attending for endoscopy in order t o identify factors associated with patients' experience of the unsedated ex amination. Methods: We studied 508 patients attending for routine diagnosti c gastroscopy. Clinical and endoscopic data were collected and patients com pleted a two-part questionnaire assessing their anxiety with, and experienc e of, the procedure. Results: Thirty-nine subjects failed to complete the i nitial unsedated endoscopy. Failure to tolerate endoscopy was associated wi th younger age (P = 0.002) and examination with a standard-bore (greater th an or equal to9.0mm) endoscope (P=0.004). High levels of patient discomfort during the procedure were associated with younger age (P < 0.001), high le vels of pre-endoscopic anxiety (P < 0.001), high levels of pre-endoscopic d iscomfort due to throat spray (P=0.02) and examination with a standard-bore endoscope (P < 0.001). Preference for sedation during future examinations was related to female gender (P = 0.02), young age (P = 0.02), high levels of apprehension (P < 0.001), the examining doctor (P = 0.002) and use of a standard-bore endoscope (P < 0.001). Conclusions: Discrete clinical charact eristics and endoscopic variables are associated with patients' experience of unsedated endoscopy. Further work might result in an algorithm for ident ifying patients who would benefit from sedation prior to gastroscopy.