The effect of Virtual Reality distraction on discomfort, pain and anxiety during unsedated gastroscopy: a randomized controlled trial

Aims Gastroscopy is a frequently performed procedure in gastroenterology due to demand of the patients. Many patients prefer sedation though this is a costly procedure due to the need of monitoring the patients during and after sedation. Unsedated gastroscopy is a lot cheaper however it is an unpleasant procedure.

A device with 3-D VR glasses can be used to minimize patient discomfort in various medical procedures. We studied whether using VR glasses in unsedated gastroscopy can minimize patient discomfort. We used validated psychological measurements (NRS scale, STAI-DY-1) to study Virtual Reality (VR) distraction on discomfort, pain and anxiety.

Methods We compared the levels of pain (NRS) and anxiety (STAI-DY-1) in 50 patients with unsedated gastroscopy (UG) versus 39 patients with unsedated gastroscopy using the VR glasses (VR) in a randomized controlled trial. We used a virtual reality head set projecting 360 video into 2 independent lenses using 3 videos featuring swimming dolphins, cows in the Alps or sunrise near a lake. NRS and STAI-DY-1 were measured 5-7 days before (T1), 15 min before (T2) and 15 minutes after (T4) gastroscopy. 3 patients were excluded due to missing values at T4. During gastroscopy 2 nurses observed patient comfort level (T3). 3 Months after gastroscopy we asked about patient satisfaction and willingness to undergo a next procedure. NRS and STAI-DY-1 were compared both between groups and intra-individually as well. The procedures were performed by two endoscopists in a general hospital.

Results Between the UG and VR group there were no differences in NRS and STAI-DY-1 at time points T1, T2 and T4. At T1 the STAI-DY-1 was 36.9 vs 35.7. At T2 the STAI-DY-1 was 41.1 vs 40.9 and NRS was 4 vs 3 (p=0.6). At T4 the STAI-DY-1 was 36.1 vs 35.4 and NRS was 2 vs 2 (p=0.7). There was a decrease in NRS and STAI-DY-1 after gastroscopy in both groups. The intra individual changes in NRS and STAI-DY-1 between the UG and VR groups were not different between time points T1, T2 and T4 (repeated measures ANOVA p=0.8) The patient comfort level (T3) between groups were the same (scale 0 – 10: mean value 7 vs 7 p=0.6). The self-reported willingness to undergo unsedated vs sedated gastrointestinal endoscopy in the future was not different.

Conclusions Virtual Reality distraction did not objectively reduce patient discomfort, pain and anxiety before, during or after procedure in unsedated gastroscopy. Still it is a cheap and non invasive measure to potentially reduce stress in specific subgroups undergoing unsedated gastroscopy. As some patients reported a large benefit it is advisable to include VR in procedures like unsedated gastroscopy.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025