Cheung Justin, Bailey Robert, Veldhuyzen van Zanten Sander, McLean Ross, Fedorak Richard N, Morse John, Millan Mario, Guzowski Tom, Goodman Karen J
Division of Gastroenterology, University of Alberta Hospital, Edmonton, Alberta, Canada.
Can J Gastroenterol. 2008 Nov;22(11):917-22. doi: 10.1155/2008/323027.
Unsedated transnasal gastroscopy is a technique with unverified clinical advantages.
To evaluate the efficacy and procedure times with transnasal gastroscopy by physicians with no previous experience in transnasal endoscopy.
Unsedated transnasal gastroscopy using 4.9 mm ultrathin transnasal gastroscopes with randomization to two different biopsy forceps was prospectively evaluated during a single day in January 2008. The outcomes included patient tolerance (scale: 1, no discomfort; 10, severe discomfort), physician technical assessment (1, excellent; 10, very poor), gastric biopsy quality, adverse events and procedure times.
Twenty patients underwent transnasal gastroscopy. Nineteen patients (95%) successfully completed transnasal gastroscopy. The patient-reported mean (+/- SD) overall discomfort level during the procedure was 4.0+/-1.9 compared with a physician-estimated level of 3.2+/-1.7 (P=0.04). Only 10% (n=2) reported they would have preferred sedated over unsedated gastroscopy. Mean total encounter time from anesthesia to discharge was 33.5+/-9.3 min. The time from anesthesia to insertion was 7.0+/-5.3 min and from room exit to discharge 6.2+/-2.9 min. No patients who had gastric biopsies taken (zero of 14) had any of unacceptable quality. The only adverse event was distressing sensations (dyspnea, dizziness) in one patient that started during pre-endoscopy anesthetic application, persisting postendoscopy, but without any abnormalities in vital signs.
Assuming the adverse event was a rare reaction, early experience with unsedated ultrathin transnasal gastroscopy was an efficient, effective and well-tolerated procedure for evaluation of the upper gastrointestinal tract.
非镇静经鼻胃镜检查是一种临床优势未经证实的技术。
评估此前无经鼻内镜检查经验的医生进行经鼻胃镜检查的疗效及操作时间。
2008年1月的某一天，前瞻性评估使用4.9毫米超细经鼻胃镜进行非镇静经鼻胃镜检查，并随机使用两种不同活检钳的情况。结果包括患者耐受性（评分：1，无不适；10，严重不适）、医生技术评估（1，优秀；10，非常差）、胃活检质量、不良事件及操作时间。
20例患者接受经鼻胃镜检查。19例患者（95%）成功完成经鼻胃镜检查。患者报告的操作过程中总体不适平均水平（±标准差）为4.0±1.9，而医生估计水平为3.2±1.7（P = 0.04）。只有10%（n = 2）的患者表示他们更倾向于镇静状态下而非非镇静状态下的胃镜检查。从麻醉到出院的平均总就诊时间为33.5±9.3分钟。从麻醉到插入胃镜的时间为7.0±5.3分钟，从离开检查室到出院的时间为6.2±2.9分钟。接受胃活检的患者中（14例中的0例）没有出现任何质量不合格的情况。唯一的不良事件是1例患者在术前麻醉应用期间开始出现的痛苦感觉（呼吸困难、头晕），在内镜检查后仍持续存在，但生命体征无任何异常。
假设该不良事件是一种罕见反应，早期非镇静超细经鼻胃镜检查经验是一种评估上消化道的高效、有效且耐受性良好的操作。
