Assessment of the Accuracy of Endoscopist-estimated Discomfort during Esophagogastroduodenoscopy

Abstract

Objective: To ensure a comfortable esophagogastroduodenoscopy (EGD), the patients' discomfort must be acknowledged.

Methods: The participants underwent EGD. The analysis used the number of gag reflexes reported by an endoscopist, estimated discomfort (minimum to maximum discomfort) by an endoscopist, and discomfort scores reported by the participants using a numerical rating scale (0–10). The background factors of individuals whose reported discomfort differed from those estimated by an endoscopist were analyzed.

Results: The analysis included 652 benzodiazepine-free participants. The participants' median discomfort score corresponding was one, two, three, five, six, and 7.5 for 0, 1–2, 3–5, 6–10, 11–19, and ≥20 gag reflexes, respectively. The correlation coefficient between the number of gag reflexes and discomfort score reported by the participants was 0.41 (p<0.001). The correlation coefficient between the endoscopist-estimated discomfort and participants' discomfort score was 0.48 (p<0.001). The incidence of cases in which participants reported a discomfort score ≥5 despite no gag reflex and minimum endoscopist-estimated discomfort was 7.6% (28/369). Factors that were significantly associated with these cases included female sex, younger age, absence of pethidine use, and transnasal endoscopy.

Conclusion: In EGD, it is important to recognize that it is not uncommon for patients who appear comfortable to actually be experiencing discomfort.