Reply to Dr. Lapeyre: Duration of Esophagogastroduodenoscopy Procedures

We are grateful for the critical comments by Dr. Lapeyre. The mean duration of endoscopic procedures is an issue continually being debated.

There have only been a few published reports on factors that may influence the duration of procedures. Fisher at al. [1] showed that avoiding sedation in the outpatient setting may lead to faster and easier endoscopies. This may suggest that there are differences in the selected patients in the studies concerned, since up to 44 % of patients in the conventional esophagogastroduodenoscopy group described by Preiss et al. [2] required additional sedation, compared to none in our study population. In our study, only 10 of 13 patients in the transnasal group in whom the procedure failed needed additional sedation. Preiss et al. conducted their study in an in-patient hospital setting, with probably only a small proportion of their cases involving outpatient procedures. By contrast, our study was carried out in a specialist outpatient endoscopy center. There may have been an additional selection bias in that only one-third of the consecutive patients in our series consented to undergo endoscopy without sedation.

The different procedure durations may also have resulted from different methods of conducting the procedures. In our study, the examinations were performed only by two well-trained, board-certified gastroenterologists. We are not aware of the level of experience of the investigators in the study by Preiss et al.

We would therefore still consider that transnasal upper gastrointestinal endoscopy is not appropriate in the outpatient setting, since there is little or no benefit for patients with regard to handling, duration of the examination, or safety - while for the examiner, the technical performance is poorer than with current standard video endoscopes.

Reference

• 1 Fisher N C, Bailey S, Gibson J A. A prospective, randomized controlled trial of sedation versus no sedation in outpatient diagnostic upper gastrointestinal endoscopy.  Endoscopy. 1998;  30 21-24
• 2 Preiss C, Charton J P, Schumacher B, Neuhaus H. A randomized trial of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) versus peroral small-caliber EGD versus conventional EGD.  Endoscopy. 2003;  35 641-646