Tsuboi Masaru, Arai Makoto, Maruoka Daisuke, Matsumura Tomoaki, Nakagawa Tomoo, Katsuno Tatsuro, Yokosuka Osamu
Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Scand J Gastroenterol. 2013 Jul;48(7):884-9. doi: 10.3109/00365521.2013.800989. Epub 2013 Jun 3.
Emergence of image-enhanced endoscopy has enabled an early detection of pharyngeal carcinoma. Pharyngeal observation during esophagogastroduodenoscopy (EGD) is sometimes difficult because of excessive reflexes and is a great burden to the patients and impacts on their cardiopulmonary function. In this study, the authors aimed to evaluate the utility of transnasal EGD (TN-EGD) in comparison with sedated and unsedated transoral EGD (TO-EGD) in pharyngeal observation using a continuous monitoring device.
A total of 70 patients receiving diagnostic EGD (unsedated TN-EGD, sedated TO-EGD, and unsedated TO-EGD) were enrolled in this study and were evaluated by the following three criteria: (1) numbers of patients with excessive gag and/or cough reflex, (2) vital signs before and during the pharyngeal observation, and (3) response to the request for vocalization or breath-holding.
Unsedated TN-EGD, sedated TO-EGD, and unsedated TO-EGD were performed in 30, 20, and 20 patients, respectively. The rate of gag reflex was significantly lower in TN-EGD than in both types of TO-EGD (0% vs. 30%, chi-square test, p < 0.005). The changes in average values of both arterial oxygen saturation (SpO2) and pulse rate (PR) in TN-EGD were smaller than those in sedated TO-EGD (-0.23% vs. -1.23% in SpO2 and 1.57 vs. 8.11 bpm in PR, p < 0.01, respectively). Unsedated TN-EGD patients could respond to the instructions of utterance and breath-holding during the observation (p < 0.05, p < 0.001, respectively).
Unsedated TN-EGD is safe and feasible for pharyngeal observation during normal EGD examination.
图像增强型内镜的出现使得早期发现咽癌成为可能。在食管胃十二指肠镜检查（EGD）期间观察咽部有时因过度反射而困难，这对患者来说是很大的负担，并会影响其心肺功能。在本研究中，作者旨在使用连续监测设备评估经鼻EGD（TN-EGD）与镇静和非镇静经口EGD（TO-EGD）在咽部观察方面的效用。
本研究共纳入70例接受诊断性EGD的患者（非镇静TN-EGD、镇静TO-EGD和非镇静TO-EGD），并通过以下三个标准进行评估：（1）有过度恶心和/或咳嗽反射的患者数量；（2）咽部观察前后的生命体征；（3）对发声或屏气要求的反应。
分别对30例、20例和20例患者进行了非镇静TN-EGD、镇静TO-EGD和非镇静TO-EGD检查。TN-EGD的恶心反射发生率显著低于两种类型的TO-EGD（0%对30%，卡方检验，p<0.005）。TN-EGD中动脉血氧饱和度（SpO2）和脉搏率（PR）的平均值变化小于镇静TO-EGD（SpO2分别为-0.23%对-1.23%，PR分别为1.57对8.11次/分钟，p<0.01）。非镇静TN-EGD患者在观察期间能够对发声和屏气指令做出反应（分别为p<0.05，p<0.001）。
在正常EGD检查期间，非镇静TN-EGD用于咽部观察是安全可行的。
