Abstract
Background and Study Aims: The majority of gastrointestinal endoscopists in the United Kingdom routinely use
intravenous sedation prior to diagnostic upper gastrointestinal endoscopy. We conducted
a prospective, randomized controlled clinical trial to help determine whether the
use of sedation influences the duration, safety, and tolerance of diagnostic upper
gastrointestinal endoscopy.
Patients and Methods: Adults referred for outpatient diagnostic upper gastrointestinal endoscopy were invited
to participate in the study. Patients with a history of previous upper gastrointestinal
endoscopy or dysphagia were excluded. Patients were prospectively randomized to sedation
with intravenous midazolam (5 mg for those under 65 years or 3 mg for those aged 65
or more), or no sedation. All patients were given topical oropharyngeal anaesthesia
with 100 mg lignocaine spray. Outcome measures included duration of procedure, ease
of procedure (as assessed by medical and nursing staff), tolerance of procedure (as
assessed by patients), and incidence of complications.
Results: 100 patients were randomized to receive sedation or no sedation. The two groups were
well matched for age, sex, and number of biopsies taken during the procedure. In the
non-sedated group, the duration of endoscopy tended to be reduced and the procedure
tended to be easier according to the endoscopists' assessment (neither of these observations
was significant). The sedated group reported greater comfort for the procedure (P < 0.001), although both groups tolerated the procedure well, and the majority in
both groups preferred to have any future procedure repeated in the same manner. There
were no serious adverse events in either group.
Conclusions: In patients who are willing to contemplate upper gastrointestinal endoscopy without
sedation, the avoidance of sedation may lead to faster and easier endoscopies, without
any increased risk of procedural difficulties or adverse events.
