Jowhari Fahd, Hookey Lawrence
Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
J Can Assoc Gastroenterol. 2020 Jun;3(3):120-126. doi: 10.1093/jcag/gwy074. Epub 2019 Jan 19.
Same day bidirectional endoscopies (esophagogastroduodenoscopies [EGD]s and colonoscopies) are routinely performed. However, the best sequence of procedures is unknown, as is whether the use of carbon dioxide (CO) affects the preferred sequence of procedures. This study aims to determine the preferred sequence of procedures and choice of insufflation gas (air or CO) in patients undergoing same day bidirectional endoscopies.
Two hundred adults with a clinical indication for same day bidirectional endoscopies were randomized equally into four groups: A1 (EGD first, CO as insufflator); A2 (EGD first, air as insufflator); B1 (colonoscopy first, CO as insufflator); and B2 (colonoscopy first, air as insufflator). All procedures were performed with conscious sedation (Midazolam/Fentanyl). The primary outcome was patients' overall comfort/satisfaction with the procedures and sedation received, as assessed by questionnaires and validated scoring scales (Nurse-Assessed Patient Comfort Score [NAPCOMS], La Crosse [WI]) collected during the procedures, before discharge, and on day 7 postprocedure.
Two hundred patients were randomized, with data available for 186. Mean Midazolam dose between groups was significantly less in the EGD first groups (=0.01). During the procedures, no differences were found in patients' comfort as per the nurse reported NAPCOMS scores (=0.19) or the Lacrosse (WI) endoscopy scores (=0.05). On postprocedure days 0 and 7, no differences were found in the patients' reported Lacrosse (WI) scores, nausea, sore throat, dizziness, satisfaction with sedation or overall level of procedural satisfaction (>0.05 for each). However, bloating and discomfort were significantly lower in the CO arms (<0.001).
This randomized controlled trial using validated patient comfort scoring assessments for same day bidirectional endoscopies demonstrated that the sequence of procedures affects the sedation used but does not affect overall patient comfort or satisfaction. Lesser sedation is needed in the EGD first group, and less postprocedural abdominal pain/discomfort and bloating is seen with CO insufflation.
同日进行双向内镜检查（食管胃十二指肠镜检查[EGD]和结肠镜检查）是常规操作。然而，最佳的操作顺序尚不清楚，使用二氧化碳（CO₂）是否会影响首选的操作顺序也不清楚。本研究旨在确定同日进行双向内镜检查患者的首选操作顺序以及充气气体（空气或CO₂）的选择。
200名有同日双向内镜检查临床指征的成年人被平均随机分为四组：A1组（先进行EGD，使用CO₂作为充气剂）；A2组（先进行EGD，使用空气作为充气剂）；B1组（先进行结肠镜检查，使用CO₂作为充气剂）；B2组（先进行结肠镜检查，使用空气作为充气剂）。所有操作均在清醒镇静（咪达唑仑/芬太尼）下进行。主要结局是通过问卷和经过验证的评分量表（护士评估的患者舒适度评分[NAPCOMS]，拉克罗斯[威斯康星州]）在操作期间、出院前和术后第7天收集的数据，评估患者对操作和所接受镇静的总体舒适度/满意度。
200名患者被随机分组，186名患者有可用数据。先进行EGD的组之间的平均咪达唑仑剂量显著较低（P = 0.01）。在操作过程中，根据护士报告的NAPCOMS评分（P = 0.19）或拉克罗斯（威斯康星州）内镜评分（P = 0.05），患者的舒适度没有差异。在术后第0天和第7天，患者报告的拉克罗斯（威斯康星州）评分、恶心、喉咙痛、头晕、对镇静的满意度或总体操作满意度没有差异（每项P>0.05）。然而，CO₂组的腹胀和不适明显较低（P<0.001）。
这项针对同日双向内镜检查使用经过验证的患者舒适度评分评估的随机对照试验表明，操作顺序会影响所用的镇静，但不影响患者的总体舒适度或满意度。先进行EGD的组需要较少的镇静，并且使用CO₂充气时术后腹痛/不适和腹胀较少。
