Does Sedation Affect Examination of Esophagogastric Junction during Upper Endoscopy?
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Purpose: During sedated esophagogastroduodenoscopy (EGD), patients may not be able to perform inspiration, which is necessaryto examine the esophagogastric junction. Therefore sedation may affect diagnosis of gastroesophageal reflux-related findings. The aim of our study was to investigate the effect of sedation on diagnosis of gastroesophageal reflux-related findings during EGD. Materials and Methods: This retrospective study evaluated 28914 patients older than 20 years who underwent EGD at our institutionbetween January 2011 and December 2011. Ultimately, 1546 patients indicated for EGD for health check-up and symptom evaluation were included. Results: There were 18546 patients who had diagnostic EGD: 10471 patients (56%) by non-sedated EGD and 8075 patients (43%) by sedated EGD. After statistical adjustment for age, sex, and body mass index, minimal change esophagitis, and hiatal hernia were significantly less frequently observed in the sedated EGD group [odds ratio (OR), 0.651; 95% confidence interval (CI), 0.586 to 0.722 and OR, 0.699; 95% CI, 0.564 to 0.866]. Nevertheless, there was no significant difference in other findings at the gastroesophagealjunction, such as reflux esophagitis with Los Angeles classification A, B, C, and D or Barrett’s esophagus, between the two groups. Similarly, there were no differences in early gastric cancer, advanced gastric cancer, and gastric ulcer occurrence. Conclusion: Sedation can impede the detection of minimal change esophagitis and hiatal hernia, but does not influence detectionof reflux esophagitis of definite severity and Barrett’s esophagus.
Abstract
Purpose: During sedated esophagogastroduodenoscopy (EGD), patients may not be able to perform inspiration, which is necessaryto examine the esophagogastric junction. Therefore sedation may affect diagnosis of gastroesophageal reflux-related findings. The aim of our study was to investigate the effect of sedation on diagnosis of gastroesophageal reflux-related findings during EGD. Materials and Methods: This retrospective study evaluated 28914 patients older than 20 years who underwent EGD at our institutionbetween January 2011 and December 2011. Ultimately, 1546 patients indicated for EGD for health check-up and symptom evaluation were included. Results: There were 18546 patients who had diagnostic EGD: 10471 patients (56%) by non-sedated EGD and 8075 patients (43%) by sedated EGD. After statistical adjustment for age, sex, and body mass index, minimal change esophagitis, and hiatal hernia were significantly less frequently observed in the sedated EGD group [odds ratio (OR), 0.651; 95% confidence interval (CI), 0.586 to 0.722 and OR, 0.699; 95% CI, 0.564 to 0.866]. Nevertheless, there was no significant difference in other findings at the gastroesophagealjunction, such as reflux esophagitis with Los Angeles classification A, B, C, and D or Barrett’s esophagus, between the two groups. Similarly, there were no differences in early gastric cancer, advanced gastric cancer, and gastric ulcer occurrence. Conclusion: Sedation can impede the detection of minimal change esophagitis and hiatal hernia, but does not influence detectionof reflux esophagitis of definite severity and Barrett’s esophagus.
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