Garcia Ruel T, Cello John P, Nguyen Mindie H, Rogers Stanley J, Rodas Alex, Trinh Huy N, Stollman Neil H, Schlueck Gail, McQuaid Kenneth R
Division of Gastroenterology, University of California, San Francisco, USA.
Gastroenterology. 2003 Dec;125(6):1606-12. doi: 10.1053/j.gastro.2003.08.034.
BACKGROUND & AIMS: In the United States, upper gastrointestinal endoscopy is usually performed using intravenous sedation. Sedation increases the rate of both complications and costs of endoscopy. Unsedated esophagogastroduodenoscopy (EGD) using conventional 8-11-mm endoscopes is an alternative to sedated endoscopy but is generally perceived as unacceptable to many American patients. Unsedated EGD using ultrathin 5-6-mm endoscopes is better tolerated. A randomized trial comparing unsedated ultrathin EGD (UT-EGD) with sedated conventional EGD (C-EGD) in a diverse American population is needed.
In this multicenter, randomized, controlled trial, 80 patients scheduled to undergo elective outpatient EGD were randomized to unsedated UT-EGD or sedated C-EGD. The study was carried out at San Francisco General Hospital, San Francisco Veterans Affairs Medical Center, and the Liver and Digestive Health Medical Clinic, San Jose.
Baseline characteristics of patients randomized to unsedated UT-EGD and sedated C-EGD were similar. Moreover, there were no significant differences in overall patient satisfaction and willingness to repeat endoscopy in the same manner among the 2 study groups. There was, however, a significant difference in median total procedure time between the 2 study groups of 1.5 hours (P < 0.0001). The mean (+/- SD) total procedure cost was 512.4 US dollars (+/- 100.8 US dollars) for sedated C-EGD and 328.6 US dollars (+/- 70.3 US dollars) for unsedated UT-EGD (P < 0.0001).
Patients undergoing unsedated UT-EGD are as satisfied as patients undergoing sedated C-EGD and are just as willing to repeat an unsedated UT-EGD. Unsedated UT-EGD was also faster, less costly, and may allow greater accessibility to this procedure.
在美国，上消化道内镜检查通常采用静脉镇静。镇静会增加内镜检查的并发症发生率和费用。使用传统的8 - 11毫米内镜进行非镇静食管胃十二指肠镜检查（EGD）是镇静内镜检查的一种替代方法，但许多美国患者通常认为这种方法不可接受。使用5 - 6毫米超薄内镜进行非镇静EGD的耐受性更好。需要在美国不同人群中进行一项随机试验，比较非镇静超薄EGD（UT - EGD）与镇静传统EGD（C - EGD）。
在这项多中心、随机、对照试验中，80例计划接受择期门诊EGD的患者被随机分为非镇静UT - EGD组或镇静C - EGD组。该研究在旧金山总医院、旧金山退伍军人事务医疗中心以及圣何塞的肝脏与消化健康医疗诊所进行。
随机分为非镇静UT - EGD组和镇静C - EGD组的患者基线特征相似。此外，两个研究组在总体患者满意度以及以相同方式重复内镜检查的意愿方面没有显著差异。然而，两个研究组之间的中位总操作时间存在显著差异，为1.5小时（P < 0.0001）。镇静C - EGD的平均（±标准差）总操作成本为512.4美元（±100.8美元），非镇静UT - EGD为328.6美元（±70.3美元）（P < 0.0001）。
接受非镇静UT - EGD的患者与接受镇静C - EGD的患者一样满意，并且同样愿意重复非镇静UT - EGD。非镇静UT - EGD操作更快、成本更低，可能使更多人能够接受该检查。
