Department of Gastroenterology, Shenzhen Bao'an District Songgang People's Hospital, No.2, Shajiang Road, Baoan District, Shenzhen, 518105, Guangdong, China.
Clinical Research Center, Guangming District, The Seventh Affiliated Hospital, Sun Yat-Sen University, No.628, Zhenyuan Road, Shenzhen, 518107, Guangdong, China.
BMC Gastroenterol. 2022 Jun 6;22(1):287. doi: 10.1186/s12876-022-02364-0.
For patients taking esophagogastroduodenoscopy (EGD), sedation should ideally be used individually based on patients' comfort and tolerance level. However, currently there is no valid predictive tool. We undertook this study to develop and temporally validate a self-assessment tool for predicting discomfort and tolerance in Chinese patients undergoing EGD.
We recruited 1522 patients undergoing routine diagnostic EGD without sedation. We collected candidate predictor variables before endoscopy and evaluated discomfort and tolerance with a 5-point visual analogue scale after the procedure. We developed logistic regression predictive models based on the first 2/3 of participants, and evaluated the calibration and discrimination of the models in the later 1/3 of patients.
30.2% and 23.0% participants reported severe discomfort or poor tolerance to EGD respectively. The predictive factors in the model for discomfort included sex, education, expected level of discomfort, and anxiety before endoscopy. The model for tolerance included income, expected level of discomfort, and anxiety before endoscopy. In the validation population, the established models showed a moderate discriminative ability with a c-index of 0.74 for discomfort and 0.78 for tolerance. Hosmer-Lemeshow test suggested the models had fine calibration ability (discomfort: P = 0.37, tolerance: P = 0.41).
Equations for predicting discomfort and tolerance in Chinese patients undergoing EGD demonstrated moderate discrimination and variable calibration. Further studies are still required to validate these tools in other population.
Chinese Clinical Trial Registry (ChiCTR1800020236).
对于接受食管胃十二指肠镜检查（EGD）的患者，理想情况下应根据患者的舒适度和耐受水平个体化使用镇静剂。然而，目前尚没有有效的预测工具。我们进行了这项研究，旨在开发并暂时验证一种用于预测中国接受 EGD 患者不适和耐受性的自我评估工具。
我们招募了 1522 名未经镇静接受常规诊断性 EGD 的患者。我们在检查前收集候选预测变量，并在检查后使用 5 分视觉模拟量表评估不适和耐受性。我们基于前 2/3 的参与者开发了逻辑回归预测模型，并在后续的 1/3 患者中评估了模型的校准和区分能力。
分别有 30.2%和 23.0%的参与者报告 EGD 检查时感到严重不适或耐受不良。模型中不适的预测因素包括性别、教育程度、预期不适程度和内镜检查前焦虑。模型中耐受的预测因素包括收入、预期不适程度和内镜检查前焦虑。在验证人群中，所建立的模型对不适和耐受均具有中等的区分能力，不适的 C 指数为 0.74，耐受的 C 指数为 0.78。Hosmer-Lemeshow 检验表明模型具有良好的校准能力（不适：P=0.37，耐受：P=0.41）。
用于预测中国接受 EGD 患者不适和耐受的方程具有中等的区分能力和可变的校准能力。仍需要进一步的研究来验证这些工具在其他人群中的适用性。
中国临床试验注册中心（ChiCTR1800020236）。
