Department of Gastroenterology, Songgang People's Hospital, The Second Hospital Group of Baoan, Shenzhen, Guangdong, China.
Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
PLoS One. 2019 Feb 19;14(2):e0212180. doi: 10.1371/journal.pone.0212180. eCollection 2019.
To evaluate the associations of pre-endoscopy anxiety with discomfort and tolerance in patients undergoing unsedated esophagogastroduodenoscopy (EGD).
This is a hospital-based cohort study of 348 patients undergoing routine, non-advanced EGD without sedation. The primary outcomes were discomfort and tolerance. The anxiety before endoscopy was evaluated with a 10-point visual analogue scale (VAS). The associations of pre-endoscopy anxiety with the outcomes were evaluated with logistic regression adjusting for potential confounders like age, sex, and body mass index.
Seventy patients reported severe discomfort and 56 patients reported poor tolerance after endoscopy. The risk of severe discomfort increased with pre-endoscopy anxiety and reached a platform around 7-10 points. Compared with the participants with low pre-endoscopy anxiety, those with moderate (adjusted odds ratio [OR] 2.70, 95% confidence interval [CI] 1.17 to 6.22) and high level of anxiety (adjusted OR 6.87, 95% CI 2.16 to 21.79) were associated with a gradual increase in the risk of severe discomfort (P-trend < 0.001). The association between pre-endoscopy anxiety and tolerance was linear, with an adjusted OR of 1.67(95% CI 1.33 to 2.08) for a 1-score increase in pre-endoscopy anxiety VAS. The associations were not modified by age, sex, pharyngitis, duration of endoscopy, and diameter of the endoscope.
Pre-endoscopy anxiety was an independent predictor of severe discomfort and poor tolerance in Chinese patients undergoing unsedated EGD. Our findings suggested the importance of the management of anxiety to reduce adverse endoscopic experience and taking high level of anxiety as an indication for sedation.
评估无镇静食管胃十二指肠镜检查（EGD）前焦虑与患者不适和耐受性的相关性。
这是一项基于医院的队列研究，纳入了 348 例行常规、非高级 EGD 且未镇静的患者。主要结局为不适和耐受性。使用 10 分视觉模拟量表（VAS）评估内镜检查前的焦虑程度。使用逻辑回归调整年龄、性别和体重指数等潜在混杂因素，评估内镜检查前焦虑与结局的相关性。
70 例患者报告内镜检查后有严重不适，56 例患者报告耐受性差。随着内镜检查前焦虑的增加，严重不适的风险逐渐增加，并在 7-10 分左右达到平台。与内镜检查前焦虑程度低的患者相比，中度（调整后的优势比 [OR] 2.70，95%置信区间 [CI] 1.17 至 6.22）和高度（调整后的 OR 6.87，95%CI 2.16 至 21.79）的患者严重不适的风险逐渐增加（趋势 P<0.001）。内镜检查前焦虑与耐受性呈线性相关，内镜检查前 VAS 评分增加 1 分，调整后的 OR 为 1.67（95%CI 1.33 至 2.08）。这些相关性不受年龄、性别、咽炎、内镜检查时间和内镜直径的影响。
内镜检查前焦虑是中国行无镇静 EGD 患者严重不适和耐受性差的独立预测因素。我们的研究结果表明，管理焦虑以减少不良内镜体验的重要性，以及将高度焦虑作为镇静指征的重要性。
