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Comparison of procedural sequences in same-day bidirectional endoscopy without benzodiazepine and propofol sedation: starting at the bottom or the top

Authors
 Jae Hee Cho  ;  Jie Hyun Kim  ;  Yong Chan Lee  ;  Si Young Song  ;  Sang Kil Lee 
Citation
 JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Vol.25(5) : 899-904, 2010 
Journal Title
 JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 
ISSN
 0815-9319 
Issue Date
2010
MeSH
Adult ; Aged ; Anemia/etiology ; Benzodiazepines/therapeutic use ; Colonoscopy*/adverse effects ; Colonoscopy*/psychology ; Conscious Sedation* ; Digestive System Diseases/complications ; Digestive System Diseases/diagnosis* ; Endoscopy, Digestive System*/adverse effects ; Endoscopy, Digestive System*/psychology ; Feasibility Studies ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Hypnotics and Sedatives/therapeutic use ; Male ; Middle Aged ; Pain/etiology ; Pain Measurement ; Patient Preference ; Predictive Value of Tests ; Propofol/therapeutic use ; Prospective Studies ; Republic of Korea ; Stress, Psychological/etiology ; Surveys and Questionnaires ; Video Recording
Abstract
BACKGROUND AND STUDY AIMS: Same-day bidirectional endoscopy including esophagogastroduodenoscopy (EGD) and colonoscopy is routinely performed to evaluate anemia and gastrointestinal bleeding, as well as to conduct cancer surveillance. Numerous questions have been raised regarding the most appropriate procedural sequence and the resulting potential procedure interactions. We compared the quality and feasibility of performing EGD and colonoscopy without sedation in patients subjected to EGD-colonoscopy (Group I) or colonoscopy-EGD (Group II) sequences. PATIENTS AND METHODS: A total of 80 patients were prospectively randomized into two groups (40:40). All EGD examinations were recorded on videotape, and the quality of 18 EGD steps was assessed by three endoscopists. In addition, we analyzed the colonoscopic parameters and subjective discomfort scores of patients. RESULTS: Group I displayed significantly superior quality for retroflexion-related steps (P11-13; all median of Group I vs Group II = 2:3; P < 0.01), visualization of the angular fold (P10; Group I vs Group II = 2:3; P = 0.048), and general assessment of the stomach (P17; Group I vs Group II = 2:3; P = 0.008) and upper GI tract (P15; Group I vs Group II = 2:3; P = 0.047). Colonoscopic insertion time, total time, and prolonged insertion ratio did not differ between the two groups. Questionnaire responses indicated that EGD was perceived to be more stressful in Group II sequence. CONCLUSIONS: The quality of EGD steps is influenced by the sequence of bidirectional endoscopy. EGD is perceived to be more stressful to patients when preceded by colonoscopy. Therefore, EGD followed by colonoscopy may be the preferable procedural sequence for same-day bidirectional endoscopy.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2009.06157.x/abstract
DOI
10.1111/j.1440-1746.2009.06157.x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Song, Si Young(송시영) ORCID logo https://orcid.org/0000-0002-1417-4314
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Cho, Jae Hee(조재희)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/101021
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