PTH-060 An assessment of quality of, and factors affecting, oesophagogastroduodenoscopy (OGD)

Introduction Oesophagogastroduodenoscopy (OGD) is the accepted gold standard investigation for upper GI symptoms although quality has rarely been assessed. In this study, quality of OGD and the effects of sedation, procedural tolerance and duration of examination were investigated. Methods Consecutive out-patients undergoing OGD were recruited. Patients scored (none-severe: 0–10) procedural distress, abdominal discomfort (AD) and pain (AP). Video recordings of the OGDs were reviewed, scoring the views (score 1–5: 75% and 100% of mucosa seen) of eight upper GI stations and time spent in retroflexion and in the duodenum. Scores and times are reported as mean (±SEM). Results OGD was performed on forty patients (58±3 years old, 62.5% male, 25% sedated) by one of three endoscopists. There was a significant difference between visualisation scores (oesophagus, 4.5 (±0.1); gastro-oesophageal junction, 4.5 (±0.1); cardia, 4.0 (±0.2); fundus, 3.7 (±0.2); upper body, 3.8 (±0.1); distal body, 4.1 (±0.1); incisura, 4.0 (±0.2) and antrum, 4.9 (±0.1); Kruskal-Wallis H Test: H(7)=60.2; p 2 =520, p=0.006). Procedural distress, AD and AP were 4.9 (±0.5), 2.8 (±0.5) and 1.3 (±0.3) respectively: none correlated with views in any station apart from those with more procedural AD who had poorer views of the distal gastric body (r=-0.36 p=0.017). Sedation had no effect on distress, discomfort or pain or views of any station. Procedure time was 5 m 41 s (±18) with 55 s (±5) spent in retroflexion and 58 s (±9) in the duodenum, none of which correlated with any visualisation scores. Time spent in the duodenum correlated with increasing procedural AP (r=0.415, p=0.009). Patients (25%) who said they would decline repeat OGD reported significantly greater AP (3.0±0.9 vs 0.7±0.3) and procedural distress (7.7±0.5 vs 4.0±0.6), but their visualisation scores, procedural times or use of sedation did not differ from those who would have a repeat test. Conclusion Visualisation at OGD is variable, with excellent antral but comparatively poorer proximal gastric and incisura views. OGD is the cause of significant distress to patients, rather than discomfort or pain, although duodenal examination may be painful in some. There was little correlation of quality of views with sedation, tolerance or duration of examination.