Tai Foong Way David, Ching Hey Long, Sloan Marion, Sidhu Reena, McAlindon Mark
Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Endosc Int Open. 2022 Jun 10;10(6):E735-E744. doi: 10.1055/a-1790-5996. eCollection 2022 Jun.
Oropharyngeal intubation during Esophagogastroduodenoscopy (EGD) is uncomfortable, associated with aerosol generation and transmission of airborne microbes. Less-invasive alternatives may be better tolerated. In this study, patient tolerance and acceptability of EGD and transnasal endoscopy (TNE) have been compared with magnet-controlled capsule endoscopy (MACE). A comparison of MACE with EGD and TNE in the investigation of dyspepsia was performed. Factors affecting patient tolerance and acceptability were examined using the Endoscopy Concerns Scale (ECS) and Universal Patient Centeredness Questionnaire (UPC-Q). Patients were significantly more distressed (scoring least to most distress: 1-10) by gagging (6 vs 1), choking (5 vs 1), bloating (2 vs 1), instrumentation (4 vs 1), discomfort during (5 vs 1) and after (2 vs 1) EGD compared to MACE (all < 0.0001). Patients were more distressed by instrumentation (5 vs 1) and discomfort during (5 vs 1) TNE compared to MACE ( = 0.001). Patients were more accepting of MACE than EGD and TNE with a UPC-Q score (scoring least to most acceptable: 0-100) lower for EGD (50 vs 98, < 0.0001) and TNE (75 vs 88, = 0.007) than MACE, and a post-procedure ECS score (scoring most to least acceptable: 10-100) higher for EGD (34 vs 11, < 0.0001) and TNE (25 vs 10.5, = 0.001) than MACE. MACE would be preferred by 83 % and 64 % of patients even if EGD or TNE respectively was subsequently recommended to obtain biopsies in half of examinations. Gagging and choking during instrumentation, the main causes of patient distress during EGD, occurred less during TNE but tolerance, acceptability and patient experience favored MACE.
在食管胃十二指肠镜检查（EGD）期间进行口咽插管会让人感到不适，且会产生气溶胶并传播空气传播微生物。侵入性较小的替代方法可能更容易被耐受。在本研究中，对EGD和经鼻内镜检查（TNE）与磁控胶囊内镜检查（MACE）的患者耐受性和可接受性进行了比较。在消化不良的调查中对MACE与EGD和TNE进行了比较。使用内镜关注量表（ECS）和通用患者中心性问卷（UPC-Q）检查了影响患者耐受性和可接受性的因素。与MACE相比，患者在EGD期间因 gagging（6比1）、窒息（5比1）、腹胀（2比1）、器械操作（4比1）、检查期间（5比1）和检查后（2比1）的不适而明显更痛苦（痛苦程度从低到高评分：1 - 10）（所有P均<0.0001）。与MACE相比，患者在TNE期间因器械操作（5比1）和检查期间的不适（5比1）而更痛苦（P = 0.001）。患者对MACE的接受度高于EGD和TNE，EGD的UPC-Q评分（可接受程度从低到高评分：0 - 100）低于MACE（50比98，P<0.0001），TNE的UPC-Q评分低于MACE（75比88，P = 0.007），并且EGD（34比11，P<0.0001）和TNE（25比10.5，P = 0.001）的检查后ECS评分（可接受程度从高到低评分：10 - 100）高于MACE。即使随后分别建议进行EGD或TNE以在一半的检查中获取活检样本，仍有83%和64%的患者更倾向于选择MACE。EGD期间患者痛苦的主要原因，即器械操作期间的 gagging和窒息，在TNE期间发生较少，但耐受性、可接受性和患者体验方面MACE更具优势。
