Chen Zhihao, Liu Lingang, Tu Jiangfeng, Qin Guangming, Su Weiwei, Geng Xiaoge, Chen Xiaojun, Wu Hongguang, Pan Wensheng
Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Gastroenterology, Longsai Hospital, Ningbo, China.
PLoS One. 2017 Jun 27;12(6):e0179490. doi: 10.1371/journal.pone.0179490. eCollection 2017.
Although sedation esophagogastroduodenoscopy (EGD) is now widely used, previous research has reported that sedation during EGD exhibits a negative effect on esophagogastric junction (EGJ) exposure. Atropine might improve EGJ exposure, as noted in clinical practice. The aim of this study was to examine whether sedation had a negative effect on EGJ observation in the Chinese population, and whether atropine had some ability to act as an antidote to this unexpected secondary effect of sedation.
In this cross-sectional study, subjects were divided into the following three groups according to the methods of EGD examination: the non-sedation group, the propofol-fentanyl combined sedation group and the combined sedation with atropine administration group. The EGJ observation was assessed by a key photograph taken with the endoscopic camera 1 cm from the EGJ, which was rated on the following four-degree scale: excellent (score = 4), good (score = 3), fair (score = 2) and poor (score = 1).
The EGJ exposure was better in the sedation group administered atropine (score = 2.64±1.05) than in the sedation group (score = 1.99±1.08, P<0.05) but not as good as in the non-sedation group (score = 3.24±1.12, P<0.05). Reduced detection of EGJ diseases in the sedation group was also found, compared to the non-sedation group (P<0.05). Only the use of atropine (OR = 2.381, 95%CI: 1.297-4.371, P = 0.005) was independently associated with excellent observation of the EGJ during sedation EGD.
Combined propofol-fentanyl sedation reduces the extent of exposure of the EGJ during EGD and reduces the detection of EGJ diseases. The application of atropine in the sedation endoscopy examination helped to achieve better EGJ observation, but still cannot achieve an equal extent of exposure compared to non-sedation EGD.
尽管镇静状态下的食管胃十二指肠镜检查（EGD）目前已被广泛应用，但先前的研究报告称，EGD检查过程中的镇静对食管胃交界处（EGJ）的观察视野有负面影响。在临床实践中发现，阿托品可能会改善EGJ的观察视野。本研究的目的是探讨镇静在中国人群中对EGJ观察是否有负面影响，以及阿托品是否有能力作为镇静这一意外副作用的解药。
在这项横断面研究中，根据EGD检查方法将受试者分为以下三组：非镇静组、丙泊酚-芬太尼联合镇静组和联合使用阿托品的镇静组。通过在内镜距EGJ 1 cm处拍摄的关键照片评估EGJ观察情况，照片按以下四级评分：优秀（评分=4）、良好（评分=3）、中等（评分=2）和差（评分=1）。
使用阿托品的镇静组EGJ观察视野（评分=2.64±1.05）优于单纯镇静组（评分=1.99±1.08，P<0.05），但不如非镇静组（评分=3.24±1.12，P<0.05）。与非镇静组相比，镇静组中EGJ疾病的检出率也有所降低（P<0.05）。在镇静状态下的EGD检查中，只有使用阿托品（OR=2.381，95%CI：1.297 - 4.371，P=0.005）与EGJ的良好观察独立相关。
丙泊酚-芬太尼联合镇静会降低EGD检查期间EGJ的观察视野范围，并减少EGJ疾病的检出。在镇静内镜检查中应用阿托品有助于更好地观察EGJ，但与非镇静EGD相比，仍无法达到同等的观察视野范围。
