A pilot project in office-based diagnostic esophagogastroduodenoscopy comparing two nonintravenous methods of sedation and anesthesia
T. J. Zuber
Department of Family Medicine, Michigan State University, East Lansing, USA.
OBJECTIVE: To evaluate the performance and findings of diagnostic
esophagogastroduodenoscopy (EGD) procedures in a primary care office
setting, comparing two nonintravenous methods of sedation and anesthesia.
DESIGN: A consecutive case series of patients with appropriate indications
referred over a 13-month period for the EGD procedure was studied.
Procedure outcomes and patient acceptance were evaluated following the
procedure. SETTING: Patients were referred from community primary care
physician offices to another community private office. PATIENTS: Medically
stable adult patients with indications for nonemergent EGD were referred
for evaluation. INTERVENTION: Esophagogastroduodenoscopy was performed in
an office setting using small-caliber (7.9-mm or 9.0-mm) fiberoptic
endoscopes. Patients were given either diazepam orally and ketorolac
tromethamine intramuscularly or triazolam orally and butorphanol tartrate
spray intranasally as sedation prior to the procedure. MAIN OUTCOME
MEASURES: Clinical findings observed, histopathologic results,
complications, oxygen desaturation, cardiac dysrhythmias, and length of
procedures were recorded. Patients reported pain and satisfaction scores on
a linear numeric scale following the procedure. RESULTS: No major
complications were noted in this study population. Seventy-three percent
(52/71) of all patients rated their discomfort during the office-based EGD
procedure as mild, with 49% (35/71) giving the lowest possible pain score
rating. Ninety-six percent (68/71) of all patients rated their satisfaction
with the procedure as high, with 65% (46/71) reporting the highest possible
level of satisfaction. The study did not demonstrate a significant
difference in patient comfort or satisfaction between the two methods of
nonintravenous sedation. CONCLUSIONS: Two alternative methods to
intravenous sedation and anesthesia appear to create adequate comfort and
satisfaction for patients undergoing EGD and merit future study and
consideration.
