Background: Transnasal esophagogastroduodenoscopy (TN-EGDS) is well tolerated by patients and the examination is perceived comfortable without the need of a sedative drug. Conversely, mainly in Western literature, some authors report limitations in illumination, image quality, and working channel as affecting TN-EGDS diffusion. To overcome these disadvantages, a new transnasal endoscope (TNE) was tested but, due to its larger diameter, we have no evidence of its clinical safety and tolerability. A new adapted nasal anesthesia could be useful to improve TNE tolerance. In an independent, not sponsored, pilot prospective study we enrolled, in a busy clinical hospital setting, 30 adult patients receiving nasal atomized Lidocaine and Xylometazoline (XAL) to undergo a diagnostic TN-EGDS with TNE to evaluate its tolerance, safety, and feasibility. Methods: Three physicians enrolled inpatients and outpatients with indication to diagnostic EGDS during a 6-month period. Main outcome measures were cardio-pulmonary monitoring data and patients’ answers to an adapted questionnaire investigating pain, anxiety level, willingness to repeat the examination, operators’ scores about endoscopy quality, examination conduction and anesthesia-related complications. Results: The examination was completed by the transnasal route in 100 % of the enrolled patients, endoscopy satisfaction and feasibility were scored to nearly the highest levels by the three different physicians. A total of 29/30 patients (96.6 %) declared the willingness to repeat the same examination if needed. The mean patients’ score for overall pain was 3.7 ± 1 SD (range 1–10 by Visual Analog Scale). Mean endoscopy duration was 11.1 ± 2.6 min (range 5.0–19.0). In a total of 17/30 TN-EGDS that lasted more than 11 min, higher heart frequency variations and worse tolerance scores were found (p < 0.05). Conclusion: Our pilot study demonstrates that TN-EGDS with TNE and NA is safe, well tolerated, and feasible. The best clinical tolerance is reached when TN-EGDS lasts <11 min.

Balassone, V., Dauri, M., Cappuccio, R., Di Camillo, M., Benavoli, D., Buonomo, O.c., et al. (2015). A pilot study assessing tolerance safety and feasibility of diagnostic transnasal esophagogastroduodenoscopy using an improved larger caliber endoscope and an adapted topical anesthesia. SURGICAL ENDOSCOPY, 29(10), 3002-3009 [10.1007/s00464-014-4025-5].

A pilot study assessing tolerance safety and feasibility of diagnostic transnasal esophagogastroduodenoscopy using an improved larger caliber endoscope and an adapted topical anesthesia

BALASSONE, VALERIO;DAURI, MARIO;BUONOMO, ORESTE CLAUDIO;PETRELLA, GIUSEPPE;STROPPA, ITALO
2015

Abstract

Background: Transnasal esophagogastroduodenoscopy (TN-EGDS) is well tolerated by patients and the examination is perceived comfortable without the need of a sedative drug. Conversely, mainly in Western literature, some authors report limitations in illumination, image quality, and working channel as affecting TN-EGDS diffusion. To overcome these disadvantages, a new transnasal endoscope (TNE) was tested but, due to its larger diameter, we have no evidence of its clinical safety and tolerability. A new adapted nasal anesthesia could be useful to improve TNE tolerance. In an independent, not sponsored, pilot prospective study we enrolled, in a busy clinical hospital setting, 30 adult patients receiving nasal atomized Lidocaine and Xylometazoline (XAL) to undergo a diagnostic TN-EGDS with TNE to evaluate its tolerance, safety, and feasibility. Methods: Three physicians enrolled inpatients and outpatients with indication to diagnostic EGDS during a 6-month period. Main outcome measures were cardio-pulmonary monitoring data and patients’ answers to an adapted questionnaire investigating pain, anxiety level, willingness to repeat the examination, operators’ scores about endoscopy quality, examination conduction and anesthesia-related complications. Results: The examination was completed by the transnasal route in 100 % of the enrolled patients, endoscopy satisfaction and feasibility were scored to nearly the highest levels by the three different physicians. A total of 29/30 patients (96.6 %) declared the willingness to repeat the same examination if needed. The mean patients’ score for overall pain was 3.7 ± 1 SD (range 1–10 by Visual Analog Scale). Mean endoscopy duration was 11.1 ± 2.6 min (range 5.0–19.0). In a total of 17/30 TN-EGDS that lasted more than 11 min, higher heart frequency variations and worse tolerance scores were found (p < 0.05). Conclusion: Our pilot study demonstrates that TN-EGDS with TNE and NA is safe, well tolerated, and feasible. The best clinical tolerance is reached when TN-EGDS lasts <11 min.
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/12 - Gastroenterologia
English
Endoscopy; Feasibility; Nose; Patient compliance; Safety; Surgery
link.springer.de/link/service/journals/00464/index.htm
Balassone, V., Dauri, M., Cappuccio, R., Di Camillo, M., Benavoli, D., Buonomo, O.c., et al. (2015). A pilot study assessing tolerance safety and feasibility of diagnostic transnasal esophagogastroduodenoscopy using an improved larger caliber endoscope and an adapted topical anesthesia. SURGICAL ENDOSCOPY, 29(10), 3002-3009 [10.1007/s00464-014-4025-5].
Balassone, V; Dauri, M; Cappuccio, R; Di Camillo, M; Benavoli, D; Buonomo, Oc; Petrella, G; Stroppa, I
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2108/141513
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