Preiss C, Charton J P, Schumacher B, Neuhaus H
Dept. of Internal Medicine, Evangelisches Krankenhaus, Düsseldorf, Germany.
Endoscopy. 2003 Aug;35(8):641-6. doi: 10.1055/s-2003-41513.
Unsedated esophagogastroduodenoscopy (EGD) has advantages over sedated EGD - e. g., prevention of side effects related to sedation, less patient monitoring, and less expense. This study compared the feasibility and tolerance of transnasal small-caliber (TSC-EGD) and peroral small-caliber EGD (PSC-EGD) with conventional EGD (C-EGD).
A total of 150 patients referred for diagnostic EGD were randomly allocated to undergo either TSC-EGD, PSC-EGD, or C-EGD under local anesthesia if they agreed to receive sedation only on demand or in case of intolerance. Patients, endoscopists, and nurses completed questionnaires on the tolerability and quality of the examinations using a visual analogue scale (VAS), ranging from 1 (best/nonexistent) to 10 (worst/unbearable) after EGD. Small-caliber EGD and C-EGD were performed with 5.9-mm and 9.8-mm video endoscopes (Olympus), respectively.
The patients' age, sex, experience with EGD, and anxiety before EGD did not differ significantly between the three groups, each consisting of 50 patients. TSC-EGD failed in four of the 50 patients (8 %) because of a narrow nasal tract; they underwent PSC-EGD. Complete examinations, including the second part of the duodenum and biopsy sampling, were possible in all patients. Patients examined with an ultrathin instrument required sedation significantly less often (TSC-EGD 6 %, PSC-EGD 18 %, C-EGD 44 %; P < 0.01) and consequently spent less time in the recovery room. TSC-EGD was initially more painful on insertion, but caused less gagging (P<0.01) than peroral EGD during the whole procedure. TSC-EGD caused mild epistaxis in one case.
TSC-EGD was carried out safely and completely in 92 % of the patients. TSC-EGD and PSC-EGD were better tolerated and required sedation less often than conventional EGD. Transnasal diagnostic EGD appears to be a promising alternative to peroral EGD, as it is associated with less gagging and a high level of patient satisfaction.
非镇静状态下的食管胃十二指肠镜检查（EGD）相较于镇静状态下的EGD具有诸多优势，例如预防与镇静相关的副作用、减少患者监测以及降低费用。本研究比较了经鼻小口径（TSC-EGD）和经口小口径EGD（PSC-EGD）与传统EGD（C-EGD）的可行性和耐受性。
共有150例因诊断性EGD前来就诊的患者，如果他们同意仅在有需求或不耐受时接受镇静，则在局部麻醉下随机分配接受TSC-EGD、PSC-EGD或C-EGD。患者、内镜医师和护士在EGD后使用视觉模拟量表（VAS）完成关于检查耐受性和质量的问卷调查，VAS范围为1（最佳/不存在）至10（最差/无法忍受）。小口径EGD和C-EGD分别使用5.9毫米和9.8毫米的视频内镜（奥林巴斯）进行。
三组各有50例患者，三组患者的年龄、性别、EGD经验以及EGD前的焦虑程度无显著差异。50例接受TSC-EGD的患者中有4例（8%）因鼻道狭窄失败，转而接受PSC-EGD。所有患者均能完成包括十二指肠第二部和活检采样在内的完整检查。使用超薄器械检查的患者需要镇静的频率显著更低（TSC-EGD为6%，PSC-EGD为18%，C-EGD为44%；P<0.01），因此在恢复室的停留时间更短。TSC-EGD在插入时最初更疼痛，但在整个操作过程中引起的恶心比经口EGD少（P<0.01）。TSC-EGD有1例导致轻度鼻出血。
TSC-EGD在92%的患者中安全且完整地完成。TSC-EGD和PSC-EGD比传统EGD耐受性更好，需要镇静的频率更低。经鼻诊断性EGD似乎是经口EGD的一个有前景的替代方法，因为它引起的恶心更少且患者满意度高。
