Document Detail

Comparison of procedural sequences in same-day bidirectional endoscopy without benzodiazepine and propofol sedation: starting at the bottom or the top.
MedLine Citation:
PMID:  20546443     Owner:  NLM     Status:  MEDLINE    
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.
Jae Hee Cho; Jie Hyun Kim; Yong Chan Lee; Si Young Song; Sang Kil Lee
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  25     ISSN:  1440-1746     ISO Abbreviation:  J. Gastroenterol. Hepatol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-06-15     Completed Date:  2010-09-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  899-904     Citation Subset:  IM    
Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
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MeSH Terms
Anemia / etiology
Benzodiazepines / therapeutic use
Colonoscopy* / adverse effects,  psychology
Conscious Sedation*
Digestive System Diseases / complications,  diagnosis*
Endoscopy, Digestive System* / adverse effects,  psychology
Feasibility Studies
Gastrointestinal Hemorrhage / etiology
Hypnotics and Sedatives / therapeutic use
Middle Aged
Pain / etiology
Pain Measurement
Patient Preference
Predictive Value of Tests
Propofol / therapeutic use
Prospective Studies
Republic of Korea
Stress, Psychological / etiology
Video Recording
Reg. No./Substance:
0/Hypnotics and Sedatives; 12794-10-4/Benzodiazepines; 2078-54-8/Propofol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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