Sedation-free upper gastrointestinal endoscopy and its cost-effectiveness
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This study aimed to determine the success rate of sedation-free upper gastrointestinal (GI) endoscopy and evaluate the cost-effectiveness of this drug-free approach.The study included patients who underwent gastroscopy between February 2020 and December 2022. Demographic information such as age and gender, along with clinical data including whether the procedure was performed with sedation and the patients' tolerance status, were recorded. Statistical analysis revealed no significant difference between the sedation and sedation-free groups in terms of procedural success. Interestingly, a notable cost difference of 43% was observed between the two groups, with the sedation-free group demonstrating higher cost-effectiveness. Despite the nearly 50% higher cost associated with administering sedation, there was no significant disparity in the successful completion of the procedure between the two groups. The findings of this study indicate that sedation-free upper GI endoscopy can achieve comparable success rates to the sedation-assisted approach. Moreover, the cost-effectiveness analysis highlights the economic advantage of the drug-free alternative, given the substantial cost reduction observed in the sedation-free group. This study underscores the feasibility of implementing sedation-free procedures as a cost-effective and successful option for upper GI endoscopyKeywords:
Upper gastrointestinal endoscopy
AbstractThe presumed need for sedation in upper gastrointestinal endoscopy differs widely between countries and between endoscopists. Very little is known about patient attitudes and the factors that influence patient discomfort. We investigated all ambulatory patients scheduled for diagnostic upper GI endoscopy during a 4-month period (n = 1169) for their attitudes to sedation. One week before the examination they were asked whether they wanted sedation in addition to topical throat anesthesia. A brief description of the endoscopic procedure was given together with an explanation of presumed advantages and disadvantages of sedation. Only 399 patients (34.1%) wanted sedation. The two groups of patients were comparable as to age, gender, and previous experience of endoscopy. Of the 399 patients wanting sedative medication 54.2% were afraid of the diagnosis and 45.8% of the procedure. Male sex and young age were associated with a lower rate of preferring sedation. Patient discomfort during endoscopy was negatively correlated with age (r = -0.309; p = 0.000). Patients who had had more than one previous endoscopy had less discomfort than those without endoscopy experience (p = 0.0069). Men had less discomfort than women (p = 0.0014). The vast majority of our patients preferred 'a normal afternoon to endoscopy sedation'. Young women not previously endoscoped potentially benefit most from sedation.Key Words: Discomfortendoscopysedation
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Upper gastrointestinal endoscopy
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An HIV-infected man developed listeriosis six days after an upper gastrointestinal (GI) endoscopy. Although listeriosis has been rarely described following lower GI endoscopy, we believe this is the first case related to upper GI endoscopy.
Upper gastrointestinal endoscopy
Upper endoscopy
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Objective: To assess patients' perception of upper GI endoscopy, both with and without sedation, and based on this information to propose a sedation policy for the procedure. Methods: A prospective audit of the experience of patients undergoing upper Gl endoscopy both with and without sedation. Results: Of the 500 patients in the study, 237 had endoscopy with sedation and 263 with local anaesthetic throat spray. Sedated patients found the procedure more tolerable, but most unsedated patients felt the extra discomfort was. more than compensated for by other advantages. 87% of those patients sedated and 70% of those not sedated would choose to have the procedure repeated in the same way. Conclusion: Upper Gl endoscopy using local anaesthetic throat spray alone is well tolerated by patients. We have developed a policy on sedation which we believe could result in many more patients electively choosing to have the procedure without sedation, resulting in potential savings on cost and manpower.
Upper endoscopy
Upper gastrointestinal endoscopy
Throat
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Anxious patients tolerate endoscopy poorly. It was proposed that such patients might derive most benefit from sedation, while most non-anxious patients would prefer endoscopy with lignocaine throat spray alone. In a prospective study, 200 outpatients underwent diagnostic endoscopy after receiving one of two detailed information sheets which offered them either the choice between spray or sedation (n = 100) or the same choice but encouraged those who were anxious about endoscopy to choose sedation (n = 100). When given an informed choice, most non-anxious patients prefer not to be sedated most non-anxious patients prefer not to be sedated during diagnostic endoscopy. If patients who are anxious about the procedure are advised to choose sedation, those who nevertheless opt for topical throat spray alone find the endoscopy just as comfortable. If the endoscopy were to be repeated, 73% of the spray group and 77% of the sedation group would make the same choice again. Of 33 patients who chose spray but had been given only sedation for a previous endoscopy, 26 (79%) would choose spray again for a future endoscopy. The choice of spray or sedation should reflect the patient's view as well as that of the endoscopist.
Throat
Nasal spray
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Objective To explore the diagnostic and therapeutic value of early endoscopy in upper gastrointestinal hemorrhage. Methods 143 upper gastrointestinal hemorrhage patients were examined and treated by early endoscopy. Results 141 cases upper gastrointestinal hemorrhage patients were recovered with endoscopy, but 2 cases were of no effect so changed with operation. Conclusion Early endoscopy is a kind of convenient, easy and safe method in diagnosis and treatment of upper gastrointestinal hemorrhage.
Upper gastrointestinal endoscopy
Therapeutic Endoscopy
Upper endoscopy
Endoscopic treatment
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Knowledge of sedation trends for upper gastrointestinal endoscopy is important for health service planning, particularly in view of rapidly increasing demands on endoscopy services. However, no data are available on sedation trends in Britain over the past 10 years.To determine sedation use for routine gastroscopy in a single endoscopy unit between 1989 and 1998.This was a retrospective study of 9795 consecutive adults (mean age 56 years, range 18-100 years; 4512 females) who had undergone a gastroscopy between 1989 and 1998. Clinical, pharmacological and endoscopic data were retrieved from a computerized database.Over the 10-year study period, the sedation rate remained constant for patients undergoing therapeutic endoscopy (P=0.99) and those undergoing in-patient diagnostic examinations (P=0.63). In contrast, the sedation rate for out-patient diagnostic endoscopy decreased by 54%, from a high of 70% in 1990 to 32% in 1998 (P < 0.0001). Logistic regression analysis showed that the decline in sedation use was greater in females (P < 0.0001) than males and in procedures performed by non-consultant compared to consultant staff (P=0.01).If our results form part of a national trend, they will have important implications for cardiopulmonary monitoring strategies, recovery room practices and for complication rates due to the use of sedation for upper gastrointestinal endoscopy.
Upper gastrointestinal endoscopy
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Diagnostic upper gastrointestinal endoscopy is the most basic of endoscopy procedures and is the technique that trainee doctors first learn. Mastering the basics of endoscopy is very important because when this process is imprecise or performed incorrectly, it can severely affect a patient's health or life. Although there are several guidelines and studies that consider these basics, there are still no standard recommendations for endoscopy in Korea. In this review, basic points, including proper endoscope insertion, precise observation without blind spots, and appropriate photographing, for upper gastrointestinal endoscopy will be discussed. Keywords: Upper gastrointestinal endoscopy; Insertion; Observation; Photographing
Upper gastrointestinal endoscopy
Endoscope
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Although sedation in endoscopy is increasingly used and contributes to the quality of procedures, its role in upper gastrointestinal endoscopy (UGE) is not as well defined as in other procedures. For this reason, we conducted a prospective pilot study where the patient, once informed of the different options, decided whether or not to undergo sedation for UGE. Remarkably, almost 60% preferred not to undergo sedation, with a high degree of satisfaction and no adverse effects in any of the groups (Ferrer Rosique JA, et al. XXXIX Congreso SEED, Toledo 2017).
Upper gastrointestinal endoscopy
Upper endoscopy
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In a prospective study including 1526 consecutive endoscopies, attempts were made to characterize the benefit of upper gastrointestinal endoscopy. Before endoscopy judgements were made about the most likely diagnosis and treatment and about the degree of suspicion of upper gastrointestinal malignancy. After endoscopy the same types of judgement were made again. The study showed that about half of the endoscopies disclosed clinically significant abnormalities. Furthermore, about every third endoscopy led to unpredicted diagnostic and diagnostic and therapeutic consequences. The benefit was comparably small in patients below the age of 40 years and particularly great in patients above the age of 65, in patients submitted to endoscopy because of barium meal pathology or general suspicion of malignancy, and in patients with upper gastrointestinal bleeding. In general, the present study supports the widespread use of upper gastrointestinal endoscopy in clinical practice.
Upper gastrointestinal endoscopy
Barium meal
Upper Gastrointestinal Bleeding
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