Hu Chi-Tan
Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Am J Gastroenterol. 2008 May;103(5):1114-21. doi: 10.1111/j.1572-0241.2007.01769.x. Epub 2008 Apr 28.
Ultrathin transnasal esophagogastroduodenoscopy (UT-EGD) is well tolerated by patients, but the methods of nasal anesthesia are various.
To compare patient tolerance, safety, and adverse events between the endoscopic-guided (EGNA) and cotton-tipped applicator (CTNA) methods of nasal anesthesia.
Between September 2005 and September 2006, we conducted a prospective, randomized, controlled study in a large tertiary referral hospital in eastern Taiwan. In total, 235 consecutive patients were randomly assigned to the CTNA group or EGNA group before unsedated UT-EGD. We compared demographic data, procedural discomfort using a validated 5-point visual analog scale, optical quality, total procedure time, and adverse events between the two groups.
After randomization and exclusion, 101 (43 men and 58 women) and 103 (44 men and 59 women) patients were allocated to the CTNA and EGNA groups, respectively. Baseline characteristics and periprocedural hemodynamics of patients in the two groups were similar. There was no statistical difference in insertion failure rates between the two methods (CTNA 10.9%vs EGNA 7.7%, P= 0.59). Pain scores during both anesthesia (2.3 +/- 0.4 vs 3.5 +/- 0.6, P < 0.001) and insertion (2.8 +/- 1.2 vs 3.8 +/- 1.8, P < 0.001) were significantly lower in the EGNA group; however, the sensation of bad taste was significantly worse in the EGNA group (2.3 +/- 1.3 vs 1.9 +/- 1.4, P= 0.040). Less epistaxis happened in the EGNA group than in the CTNA group. The EGNA method had a significantly better visual capacity and shorter procedure time. More patients in the EGNA group said they would like to receive the same procedure the next time.
Compared with the CTNA method, in which the taste of lidocaine gel was more acceptable, EGNA appeared to be more tolerable, caused less epistaxis, improved visualization capacity, and reduced procedure time.
超薄经鼻食管胃十二指肠镜检查（UT-EGD）患者耐受性良好，但鼻内麻醉方法多种多样。
比较内镜引导下鼻内麻醉（EGNA）和棉棒鼻内麻醉（CTNA）方法在患者耐受性、安全性及不良事件方面的差异。
2005年9月至2006年9月，我们在台湾东部一家大型三级转诊医院进行了一项前瞻性、随机、对照研究。在未使用镇静剂的UT-EGD检查前，共235例连续患者被随机分配至CTNA组或EGNA组。我们比较了两组的人口统计学数据、使用经过验证的5分视觉模拟量表评估的操作不适感、光学质量、总操作时间及不良事件。
随机分组并排除后，分别有101例（43例男性和58例女性）和103例（44例男性和59例女性）患者被分配至CTNA组和EGNA组。两组患者的基线特征和围手术期血流动力学相似。两种方法的插入失败率无统计学差异（CTNA组为10.9%，EGNA组为7.7%，P = 0.59）。EGNA组在麻醉期间（2.3±0.4对3.5±0.6，P < 0.001）和插入过程中的疼痛评分（2.8±1.2对3.8±1.8，P < 0.001）均显著更低；然而，EGNA组的味觉不适感觉显著更差（2.3±1.3对1.9±1.4，P = 0.040）。EGNA组鼻出血的发生率低于CTNA组。EGNA方法的视觉清晰度明显更好，操作时间更短。EGNA组更多患者表示愿意下次接受相同的检查。
与利多卡因凝胶味道更易接受的CTNA方法相比，EGNA似乎更易耐受，鼻出血更少，视觉清晰度更高，操作时间更短。
