Unsedated peroral endoscopy with a new video ultrathin (UT) endoscope: patient acceptance, tolerance and diagnostic accuracy

With the advent of smaller endoscopes, mainly fiberoptic, there has been growing interest in the feasibility of unsedated routine upper endoscopy. Aim: Assess patient tolerance of unsedated routine upper endoscopy using a new 6mm UT video endoscope (Olympus XGIF-N200H) and compare its optical quality to a standard endoscope (Olympus GIF 100). Methods: 62 outpatients were recruited for unsedated UT endoscopy using topical spray followed by sedated endoscopy using a standard endoscope. After unsedated endoscopy patients were asked to complete a questionnaire assessing tolerance (mild, moderate, severe or no discomfort). When both endoscopies were completed the endoscopist recorded endoscopic findings and optical quality of the UT (good, fair, or poor). Results: 19 of 62 patients refused unsedated endoscopy because of: anxiety 12, fear of gagging 3, and unwillingness to be a study patient 4. Tolerance: 37 of 43 (86%) patients had a complete unsedated UT exam (5 of the patients did not have a GIF100 exam). 30 of 37 (81%) patients were willing to undergo future unsedated endoscopy with the UT and they tolerated UT endoscopy better than the patients that were unwilling (none/mild discomfort: 75% vs. 29%). Gender appeared to have no bearing on the willingness of a patient to have future unsedated endoscopy. However, willing patients tended to be older (50 vs. 38yrs). 6 of 43 (14%) patients failed UT endoscopy because of severe gagging (all were male, mean age of 44). Optics: Optical quality was rated good 83%, 63%, and 78% of the time in the esophagous, stomach, and duodenum respectively. Optical quality was diminished by excessive fluid and tenacious secretions. Endoscopic findings included: esophagrtis 7, lower esophageal ring 3, Barrett's 5, esophageal stricture 1, hiatal hemia 20, gastric erosions/erythema 6, gastric AVM's 1, gastric nodule/polyp 2, gastric ulcer 3, duodenal ulcer 3, duodenal erosions/erythema 7, and scalloped duodenal folds of celiac sprue 1. The UT missed 5 of 59 lesions: 3 hiatal hernias, 1 gastric erosion, and 1 small gastric ulcer. Conclusion: 69% of outpatients agreed to undergo peroral unsedated endoscopy with an UT endoscope 86% of patients tolerated a complete unsedated examination and 81% of these were willing to undergo future unsedated examinations. Optical quality of this uhrathin video endoscope was good with 92% of lesions discovered when compared to a standard instrument.