Division of Gastroenterology and Research Centre for Hepatology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Graduate Institute of Clinical Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan.
Gastrointest Endosc. 2010 Jan;71(1):11-20. doi: 10.1016/j.gie.2009.06.016. Epub 2009 Sep 12.
Methods and efficacy of nasal anesthesia before ultrathin transnasal EGD (UT-EGD) are crucial for patient tolerance.
To compare patient tolerance, safety, and adverse events between cotton-tipped applicator primed gauze pledgetting (CTGP) and endoscopic-guided aerosolized spray (EGAS) methods of nasal anesthesia.
We performed a prospective, randomized-controlled trial to compare procedural discomforts, optical quality, total procedure time, and adverse events between the CTGP and EGAS methods.
A large, tertiary referral hospital in Taiwan.
A total of 240 consecutive patients with epigastric discomfort were included in the study.
The author performed all standardized nasal anesthesia and UT-EGD using a 5.9-mm diameter transnasal endoscope.
Technical success, patient tolerability profiles, optical quality, total procedure time, and adverse events.
There was no statistical difference in insertion failure rates between the 2 methods (CTGP 0% vs EGAS 5%, P = .07). When compared with the EGAS method, CTGP reduced pain during insertions through the inferior nasal meatus (3.4 +/- 0.5 vs 3.2 +/- 0.4, P = .006), middle nasal meatus (4.0 +/- 0.7 vs 3.4 +/- 0.5, P = .002), and upper esophageal sphincter (2.9 +/- 0.7 vs 2.6 +/- 0.8, P = .005). CTGP elicited less unpleasant taste, fewer gagging episodes, and less throat pain after examination. Both methods had similar safe hemodynamic profiles, low epistaxis rates (0% vs 2%, P = .46), and comparable visual capacity and procedure time. Although similar proportions of patients in both groups would like to receive the same procedure the next time, CTGP had a higher overall tolerance.
Compared with the EGAS method, CTGP achieved a better tolerability profile and elicited less bad taste, fewer gagging episodes, and less throat pain after UT-EGD in Taiwanese patients.
在超细经鼻胃镜检查（UT-EGD）前，鼻内麻醉的方法和效果对于患者的耐受性至关重要。
比较棉花头涂抹纱布填塞（CTGP）和内镜引导喷雾（EGAS）两种鼻内麻醉方法对患者耐受性、安全性和不良事件的影响。
我们进行了一项前瞻性、随机对照试验，比较 CTGP 和 EGAS 两种方法在操作不适、光学质量、总操作时间和不良事件方面的差异。
台湾一家大型三级转诊医院。
共有 240 例上腹部不适的连续患者纳入研究。
作者使用 5.9mm 直径经鼻内镜进行所有标准化鼻内麻醉和 UT-EGD。
技术成功率、患者耐受性、光学质量、总操作时间和不良事件。
两种方法的插入失败率无统计学差异（CTGP 为 0%，EGAS 为 5%，P=0.07）。与 EGAS 方法相比，CTGP 降低了经下鼻道（3.4±0.5 比 3.2±0.4，P=0.006）、中鼻道（4.0±0.7 比 3.4±0.5，P=0.002）和上食管括约肌（2.9±0.7 比 2.6±0.8，P=0.005）插入时的疼痛。CTGP 引起的不良味觉、呛咳发作和检查后咽喉疼痛较少。两种方法的安全血液动力学特征相似，鼻出血发生率均较低（0%比 2%，P=0.46），且视觉能力和操作时间相当。尽管两组患者接受相同程序的意愿比例相似，但 CTGP 的总体耐受性更高。
与 EGAS 方法相比，在台湾患者中，CTGP 具有更好的耐受性，且在接受 UT-EGD 后引起的不良味觉、呛咳发作和咽喉疼痛更少。
